Provider Demographics
NPI:1720718059
Name:RAMOS, KEVIN ANIBAL (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ANIBAL
Last Name:RAMOS
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 1:586 E OAKRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1335
Mailing Address - Country:US
Mailing Address - Phone:201-562-0393
Mailing Address - Fax:
Practice Address - Street 1:25650 OUTER DR
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146-2096
Practice Address - Country:US
Practice Address - Phone:313-383-1897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016012811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice