Provider Demographics
NPI:1750675468
Name:DORIUS, KEVIN S (DMD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:S
Last Name:DORIUS
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 1:721 N 950 W
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-5072
Mailing Address - Country:US
Mailing Address - Phone:435-668-1642
Mailing Address - Fax:
Practice Address - Street 1:929 W SUNSET BLVD
Practice Address - Street 2:SUITE 15
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-4865
Practice Address - Country:US
Practice Address - Phone:435-656-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4919293122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist