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General NPI Number Information
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NPI Number | 1942949995
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Entity Type | Individual
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Provider Name | KEVIN SCOTT DAGENAIS DDS
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Gender | Male
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Dates
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Enumeration Date | 05/28/2022
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Last Update Date | 06/08/2022
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Provider Practice Location Address
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Address Line | 4910 E SILVER SPRINGS BLVD
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City | OCALA
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State | FL
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Zip | 34470-3268
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Country | US
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Telephone | 352-229-8583
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Fax |
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Provider Business Mailing Address
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Address Line | 6006 DARRAMOOR RD
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48301-1429
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Country | US
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Telephone | 248-345-9369
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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 | 26852
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License Number State | FL
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