Healthcare Provider Details

I. General information

NPI: 1942949995
Provider Name (Legal Business Name): KEVIN SCOTT DAGENAIS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2022
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4910 E SILVER SPRINGS BLVD
OCALA FL
34470-3268
US

IV. Provider business mailing address

6006 DARRAMOOR RD
BLOOMFIELD HILLS MI
48301-1429
US

V. Phone/Fax

Practice location:
  • Phone: 352-229-8583
  • Fax:
Mailing address:
  • Phone: 248-345-9369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number26852
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: