Provider Demographics
NPI:1689685430
Name:MAGID, KEVIN FREDERICK (DDS)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:FREDERICK
Last Name:MAGID
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 1:814 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-1869
Mailing Address - Country:US
Mailing Address - Phone:404-373-5366
Mailing Address - Fax:404-373-5366
Practice Address - Street 1:814 CHURCH ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1869
Practice Address - Country:US
Practice Address - Phone:404-373-5366
Practice Address - Fax:404-373-5366
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8694122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist