Provider Demographics
NPI:1730275108
Name:DILEO, KEVIN J (DDS)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:J
Last Name:DILEO
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 1:1208 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77630-5535
Mailing Address - Country:US
Mailing Address - Phone:409-883-3131
Mailing Address - Fax:409-883-6811
Practice Address - Street 1:1208 W ELM ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77630-5535
Practice Address - Country:US
Practice Address - Phone:409-883-3131
Practice Address - Fax:409-883-6811
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX169001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2001054OtherBCBS
TX693650OtherUNITED CONCORDIA