Provider Demographics
NPI:1831294032
Name:AXX, KEVIN T (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:T
Last Name:AXX
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 E LEXINGTON AVE UNIT 1010
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2494
Mailing Address - Country:US
Mailing Address - Phone:602-667-3600
Mailing Address - Fax:602-667-3611
Practice Address - Street 1:4141 N 32ND ST STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-4775
Practice Address - Country:US
Practice Address - Phone:602-667-3600
Practice Address - Fax:602-667-3611
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0502811223E0200X
AZD73771223E0200X
PADS0363161223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics