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General NPI Number Information
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NPI Number | 1629088265
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Entity Type | Individual
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Provider Name | KEVIN THOMAS MCGLYNN D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 07/10/2007
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Provider Practice Location Address
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Address Line | 312 KENMORE RD PENSACOLA OUTPATIENT CLINIC/DENTAL
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City | PENSACOLA
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State | FL
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Zip | 32503-7462
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Country | US
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Telephone | 850-471-7615
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Fax |
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Provider Business Mailing Address
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Address Line | 1176 OLD TRL
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City | GULF BREEZE
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State | FL
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Zip | 32563-5536
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Country | US
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Telephone | 850-932-2709
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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 | 11719
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License Number State | MD
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