Healthcare Provider Details

I. General information

NPI: 1235101627
Provider Name (Legal Business Name): KEVIN JOHN MEARS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 827 BOX 531
FPO AE
09617
IT

IV. Provider business mailing address

PSC 827 BOX 531
FPO AE
09617
IT

V. Phone/Fax

Practice location:
  • Phone: 81-811-6033
  • Fax:
Mailing address:
  • Phone: 81-811-6033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD10221
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD6550
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number33809
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: