Healthcare Provider Details

I. General information

NPI: 1114939279
Provider Name (Legal Business Name): KEVIN MICHAEL SHOWVAKER DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 03/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 CONSTITUTION BLVD SUITE D
NEW BRIGHTON PA
15066
US

IV. Provider business mailing address

PO BOX 18
NEW BRIGHTON PA
15066
US

V. Phone/Fax

Practice location:
  • Phone: 724-847-7692
  • Fax: 724-847-8766
Mailing address:
  • Phone: 724-847-7692
  • Fax: 724-847-8766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS025430L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. KEVIN MICHAEL SHOWVAKER
Title or Position: OWNER
Credential: DMD
Phone: 724-847-7692