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General NPI Number Information
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NPI Number | 1598848376
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Entity Type | Individual
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Provider Name | KEVIN B DECKER MD
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Gender | Male
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 12/09/2011
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Provider Practice Location Address
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Address Line | 32 CONKEY AVE
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City | NORWICH
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State | NY
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Zip | 13815-1762
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Country | US
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Telephone | 607-337-4174
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Fax |
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Provider Business Mailing Address
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Address Line | 251 STATE HWY #320
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City | NORWICH
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State | NY
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Zip | 13815
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Country | US
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Telephone | 607-336-3034
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 040681
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License Number State | NY
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