Provider Demographics
NPI:1770655540
Name:ARTIME, KEVIN MARCELLINO (KEVIN ARTIME DMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MARCELLINO
Last Name:ARTIME
Suffix:
Gender:M
Credentials:KEVIN ARTIME DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1353 E MOUND RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-9345
Mailing Address - Country:US
Mailing Address - Phone:217-877-1601
Mailing Address - Fax:
Practice Address - Street 1:1353 E MOUND RD
Practice Address - Street 2:SUITE 102
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-9345
Practice Address - Country:US
Practice Address - Phone:217-877-1601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice