Provider Demographics
NPI:1659451037
Name:MAILOT, KEVIN GWYNNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:GWYNNE
Last Name:MAILOT
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 1:221 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-8003
Mailing Address - Country:US
Mailing Address - Phone:918-341-3008
Mailing Address - Fax:919-341-9577
Practice Address - Street 1:221 W 1ST ST
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-8003
Practice Address - Country:US
Practice Address - Phone:918-341-3008
Practice Address - Fax:919-341-9577
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK48361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice