Provider Demographics
NPI:1134518830
Name:MCCAFFREY, KEVIN PATRICK (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:PATRICK
Last Name:MCCAFFREY
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 S COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-1239
Mailing Address - Country:US
Mailing Address - Phone:417-224-7255
Mailing Address - Fax:
Practice Address - Street 1:451 S COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-1239
Practice Address - Country:US
Practice Address - Phone:417-224-7255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-18
Last Update Date:2015-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN198941223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics