Provider Demographics
NPI:1760584197
Name:KILCOYNE, KEVIN T (DMD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:T
Last Name:KILCOYNE
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 1:6818 MARKET ST
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-2412
Mailing Address - Country:US
Mailing Address - Phone:610-352-4747
Mailing Address - Fax:
Practice Address - Street 1:6818 MARKET ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-2412
Practice Address - Country:US
Practice Address - Phone:610-352-4747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADSD24733L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice