Healthcare Provider Details

I. General information

NPI: 1104824481
Provider Name (Legal Business Name): KEVIN SCOTT MCCURRY D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 08/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 N CONNOR ST #2
SHERIDAN WY
82801-4315
US

IV. Provider business mailing address

145 N CONNOR ST #2
SHERIDAN WY
82801-4315
US

V. Phone/Fax

Practice location:
  • Phone: 307-675-1905
  • Fax: 307-675-1908
Mailing address:
  • Phone: 307-675-1905
  • Fax: 307-675-1908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number37351
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1258
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: