Basic Information
| Provider Information | |||||||||
| NPI: | 1659732113 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CASH | ||||||||
| FirstName: | KEVIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7101 HOFF ST. BLDG 9240 | ||||||||
| Address2: | |||||||||
| City: | FORT BENNING | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7065443103 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3935 E SOUTHPORT RD | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462373203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3172443000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2016 | ||||||||
| LastUpdateDate: | 04/29/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | DN013839 | GA | N | Dental Providers | Dentist | 122300000X | 12012970A | IN | Y | Dental Providers | Dentist |
No ID Information.