Provider Demographics
NPI:1205971082
Name:MCMAHON, KEVIN ROBERT (DMD)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:ROBERT
Last Name:MCMAHON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:155 BARNWOOD DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-2585
Mailing Address - Country:US
Mailing Address - Phone:859-331-3400
Mailing Address - Fax:859-331-6429
Practice Address - Street 1:155 BARNWOOD DR
Practice Address - Street 2:SUITE 1
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-2585
Practice Address - Country:US
Practice Address - Phone:859-331-3400
Practice Address - Fax:859-331-6429
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY60071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice