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General NPI Number Information
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NPI Number | 1235219296
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Entity Type | Individual
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Provider Name | KEVIN JAMES DEAKYNE DDS PC
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Gender | Male
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 470 BENNETT DR. SUITE A
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City | WARREN
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State | IN
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Zip | 46792-0307
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Country | US
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Telephone | 260-375-2626
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Fax | 260-375-2629
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Provider Business Mailing Address
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Address Line | 470 BENNETT DR. SUITE A BOX 307
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City | WARREN
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State | IN
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Zip | 46792-0307
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Country | US
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Telephone | 260-375-2626
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Fax | 260-375-2629
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12008898
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License Number State | IN
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