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General NPI Number Information
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NPI Number | 1568114775
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Entity Type | Individual
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Provider Name | KEVIN DAVIS VAN ASCH DMD
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Gender | Male
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Dates
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Enumeration Date | 01/19/2022
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Last Update Date | 05/31/2022
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Provider Practice Location Address
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Address Line | 8410 DATAPOINT DR
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City | SAN ANTONIO
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State | TX
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Zip | 78229-3220
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Country | US
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Telephone | 704-519-5068
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Fax |
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Provider Business Mailing Address
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Address Line | 14960 BULL HILL RD
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City | OAKBORO
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State | NC
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Zip | 28129-9650
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Country | US
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Telephone | 704-519-5068
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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 | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | NC
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Taxonomy #5
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12752
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License Number State | NC
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