Provider Demographics
NPI:1245722099
Name:KONSTANT, KEVIN E (DMD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:E
Last Name:KONSTANT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 S PARK RD
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-2124
Mailing Address - Country:US
Mailing Address - Phone:708-285-2720
Mailing Address - Fax:
Practice Address - Street 1:7350 W COLLEGE DR STE 105
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1187
Practice Address - Country:US
Practice Address - Phone:708-408-3323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0316171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice