Healthcare Provider Details

I. General information

NPI: 1912381864
Provider Name (Legal Business Name): KEVAN KADAVY D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2015
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2635 LINCOLN WAY STE E
CLINTON IA
52732-7229
US

IV. Provider business mailing address

2635 LINCOLN WAY STE E
CLINTON IA
52732-7229
US

V. Phone/Fax

Practice location:
  • Phone: 563-243-6622
  • Fax: 563-242-1484
Mailing address:
  • Phone: 563-243-6622
  • Fax: 563-242-1484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number09364
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: