Provider Demographics
NPI:1780930396
Name:DUNPHY, KEVIN R (DDS)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:R
Last Name:DUNPHY
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 1:2393 E VENICE AVE
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-2465
Mailing Address - Country:US
Mailing Address - Phone:941-484-6817
Mailing Address - Fax:941-480-1407
Practice Address - Street 1:2393 E VENICE AVE
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-2465
Practice Address - Country:US
Practice Address - Phone:941-484-6817
Practice Address - Fax:941-480-1407
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 19820122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist