Provider Demographics
NPI:1912182205
Name:KEVIN MUILOT DDS INC
Entity Type:Organization
Organization Name:KEVIN MUILOT DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:GWYNNE
Authorized Official - Last Name:MUILOT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-341-3008
Mailing Address - Street 1:221 W FIRST ST
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017
Mailing Address - Country:US
Mailing Address - Phone:918-341-3008
Mailing Address - Fax:918-341-9577
Practice Address - Street 1:221 W FIRST ST
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017
Practice Address - Country:US
Practice Address - Phone:918-341-3008
Practice Address - Fax:918-341-9577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK48361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty