Provider Demographics
NPI:1679577266
Name:SLOAN, KEVIN M (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:M
Last Name:SLOAN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 PAULINE BLVD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-5207
Mailing Address - Country:US
Mailing Address - Phone:734-668-8420
Mailing Address - Fax:
Practice Address - Street 1:1717 PAULINE BLVD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-5207
Practice Address - Country:US
Practice Address - Phone:734-668-8420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010133151223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics