MEDICARE: DR. KEVIN G REARDON DDS

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	019-032876	IL

General Provider Information

NPI Number	:	1932713583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN G REARDON DDS

Provider Business Mailing Address
First Line	:	479 S SPRING RD
Second Line	:
City	:	ELMHURST
State	:	IL
Zip	:	60126-3857
Country	:	US
Telephone Number	:	630-834-1218
Fax Number	:	630-834-1065

Provider Business Practice Location Address
First Line	:	479 S SPRING RD
Second Line	:
City	:	ELMHURST
State	:	IL
Zip	:	60126-3857
Country	:	US
Telephone Number	:	630-834-1218
Fax Number	:	630-834-1065

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

Provider Enumeration Date	:	09/01/2020
Last Update Date	:	04/28/2026

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