MEDICARE: DR. KEVIN MICHAEL PFEIFFER D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	8905	KY

General Provider Information

NPI Number	:	1326369653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN MICHAEL PFEIFFER D.M.D.

Provider Business Mailing Address
First Line	:	20 N GRANDE AVE STE 10
Second Line	:
City	:	FORT THOMAS
State	:	KY
Zip	:	41075-1755
Country	:	US
Telephone Number	:	859-441-1900
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 N GRANDE AVE STE 10
Second Line	:
City	:	FORT THOMAS
State	:	KY
Zip	:	41075-1755
Country	:	US
Telephone Number	:	859-441-1900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2010
Last Update Date	:	06/22/2010

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