Provider Demographics
NPI:1659403251
Name:MALTZ, KEVIN D (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:D
Last Name:MALTZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:UNIONVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06085-1131
Mailing Address - Country:US
Mailing Address - Phone:860-673-3900
Mailing Address - Fax:860-673-0038
Practice Address - Street 1:101 MAIN ST
Practice Address - Street 2:
Practice Address - City:UNIONVILLE
Practice Address - State:CT
Practice Address - Zip Code:06085-1131
Practice Address - Country:US
Practice Address - Phone:860-673-3900
Practice Address - Fax:860-673-0038
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT77261223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry