Provider Demographics
NPI:1538387337
Name:KEVLYN, MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:KEVLYN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 E BELLEVIEW AVE STE 425E
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2891
Mailing Address - Country:US
Mailing Address - Phone:303-290-0962
Mailing Address - Fax:303-721-6516
Practice Address - Street 1:8200 E BELLEVIEW AVE STE 425E
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2891
Practice Address - Country:US
Practice Address - Phone:303-290-0962
Practice Address - Fax:303-721-6516
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO100201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice