Provider Demographics
NPI:1932713583
Name:REARDON, KEVIN G (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:G
Last Name:REARDON
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 1:479 S SPRING RD
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-3857
Mailing Address - Country:US
Mailing Address - Phone:630-834-1218
Mailing Address - Fax:630-834-1065
Practice Address - Street 1:479 S SPRING RD
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-3857
Practice Address - Country:US
Practice Address - Phone:630-834-1218
Practice Address - Fax:630-834-1065
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0328761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice