Provider Demographics
NPI:1760491914
Name:POPE, KEVIN W (DDS)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:W
Last Name:POPE
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 1:4630 50TH ST
Mailing Address - Street 2:#508
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79414-3521
Mailing Address - Country:US
Mailing Address - Phone:806-792-6261
Mailing Address - Fax:806-792-6261
Practice Address - Street 1:4630 50TH ST
Practice Address - Street 2:#508
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79414-3521
Practice Address - Country:US
Practice Address - Phone:806-792-6261
Practice Address - Fax:806-792-6261
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX149751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice