Healthcare Provider Details

I. General information

NPI: 1215211685
Provider Name (Legal Business Name): KEVIN S. ALBERT DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2011
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4808 N. HIGH STREET
COLUMBUS OH
43214-1554
US

IV. Provider business mailing address

4808 N. HIGH STREET
COLUMBUS OH
43214-1554
US

V. Phone/Fax

Practice location:
  • Phone: 614-261-7210
  • Fax: 614-261-7211
Mailing address:
  • Phone: 614-261-7210
  • Fax: 614-261-7211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.024163
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.028649
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019028649
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: