Provider Demographics
NPI:1700960630
Name:MAHONEY, W KEVIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:W
Middle Name:KEVIN
Last Name:MAHONEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:W
Other - Middle Name:KEVIN
Other - Last Name:MAHONEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3915 CAUGHEY RD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-4031
Mailing Address - Country:US
Mailing Address - Phone:814-833-3505
Mailing Address - Fax:814-838-5161
Practice Address - Street 1:3915 CAUGHEY RD
Practice Address - Street 2:SUITE #1
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-4031
Practice Address - Country:US
Practice Address - Phone:814-833-3505
Practice Address - Fax:814-838-5161
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025037L1223G0001X
PADA025037A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology