Provider Demographics
NPI:1700945797
Name:CAHOW, KEVAN TROY (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVAN
Middle Name:TROY
Last Name:CAHOW
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5237 DOUGLAS DR N
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55429-3103
Mailing Address - Country:US
Mailing Address - Phone:763-536-1118
Mailing Address - Fax:763-536-2244
Practice Address - Street 1:5237 DOUGLAS DR N
Practice Address - Street 2:
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55429-3103
Practice Address - Country:US
Practice Address - Phone:763-536-1118
Practice Address - Fax:763-536-2244
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND101701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN710515100Medicaid
MN7D756OtherMPIN
MN7D756OtherMPIN