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General NPI Number Information
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NPI Number | 1245722099
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Entity Type | Individual
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Provider Name | KEVIN E KONSTANT DMD
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Gender | Male
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Dates
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Enumeration Date | 06/06/2018
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Last Update Date | 06/06/2018
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Provider Practice Location Address
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Address Line | 7350 W COLLEGE DR STE 105
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City | PALOS HEIGHTS
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State | IL
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Zip | 60463-1187
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Country | US
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Telephone | 708-408-3323
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Fax |
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Provider Business Mailing Address
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Address Line | 132 S PARK RD
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City | LA GRANGE
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State | IL
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Zip | 60525-2124
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Country | US
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Telephone | 708-285-2720
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Fax |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019.031617
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License Number State | IL
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