Provider Demographics
NPI:1134104813
Name:DENIS, KEVIN LEE (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:LEE
Last Name:DENIS
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1668 COPE AVE E
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-2655
Mailing Address - Country:US
Mailing Address - Phone:651-777-7300
Mailing Address - Fax:651-777-9131
Practice Address - Street 1:1668 COPE AVE E
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-2655
Practice Address - Country:US
Practice Address - Phone:651-777-7300
Practice Address - Fax:651-777-9131
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101721223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics