Provider Demographics
NPI:1679834899
Name:WHITE, KEVIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:WHITE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 CATALPA RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-1911
Mailing Address - Country:US
Mailing Address - Phone:859-608-3267
Mailing Address - Fax:859-626-1811
Practice Address - Street 1:120 MERIDIAN WAY STE 2
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2881
Practice Address - Country:US
Practice Address - Phone:859-608-3267
Practice Address - Fax:859-626-1811
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY91671223G0001X, 1223P0221X
IL019.030337122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist