Provider Demographics
NPI:1720141104
Name:KOVAC, DERON TODD (DMD)
Entity Type:Individual
Prefix:DR
First Name:DERON
Middle Name:TODD
Last Name:KOVAC
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 1:1102 BALTIMORE PIKE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342-1058
Mailing Address - Country:US
Mailing Address - Phone:610-358-5151
Mailing Address - Fax:610-358-2510
Practice Address - Street 1:1102 BALTIMORE PIKE
Practice Address - Street 2:SUITE 203
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-1058
Practice Address - Country:US
Practice Address - Phone:610-358-5151
Practice Address - Fax:610-358-2510
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027813L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice