MEDICARE: DR. KEVIN POWERS DMD

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	122300000X	Dentist	DN25867	FL

General Provider Information

NPI Number	:	1447826979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN POWERS DMD

Provider Business Mailing Address
First Line	:	8 WHISTLING DUCK CT
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32119-8388
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1812 DUNLAWTON AVE STE 101
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-2925
Country	:	US
Telephone Number	:	386-233-3040
Fax Number	:

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

Provider Enumeration Date	:	06/03/2021
Last Update Date	:	06/03/2021

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Directions to “ DR. KEVIN POWERS DMD” Practice Location

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