=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528987963
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEVIN MAHON DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2026
-----------------------------------------------------
Last Update Date | 07/10/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 501 W 1ST AVE
-----------------------------------------------------
City | TOPPENISH
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98948-1565
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-865-5600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 CANYON PKWY UNIT D17
-----------------------------------------------------
City | SELAH
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98942-1260
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-699-7479
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number | 70110974
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------