Provider Demographics
NPI:1013435429
Name:KEVIN G. EUBANKS, D.M.D
Entity Type:Organization
Organization Name:KEVIN G. EUBANKS, D.M.D
Other - Org Name:SOUTHERN DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-641-3883
Mailing Address - Street 1:174 CREPE MYRTLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803
Mailing Address - Country:US
Mailing Address - Phone:803-641-3883
Mailing Address - Fax:803-641-3198
Practice Address - Street 1:174 CREPE MYRTLE DRIVE
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803
Practice Address - Country:US
Practice Address - Phone:803-641-3883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-06
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3587261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3587OtherSOUTH CAROLINA BOARD