| Kevin Marvin | |
|
4904 S Clyde Morris Blvd Suite B Port Orange FL 32129 | |
| (386) 788-9959 | |
| (386) 788-9850 |
| Full Name | Kevin Marvin |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 4904 S Clyde Morris Blvd, Port Orange, Florida |
| Authorized Official Name and Position | Eugene Joseph Lecompte (OWNER/MANAGER) |
| Authorized Official Contact | 3862953815 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kevin Marvin 3890 Turtle Creek Drive Suite A Port Orange FL 32127 Ph: (386) 761-5440 | Kevin Marvin 4904 S Clyde Morris Blvd Suite B Port Orange FL 32129 Ph: (386) 788-9959 |
| NPI Number | 1043708050 |
|---|---|
| Provider Enumeration Date | 04/25/2018 |
| Last Update Date | 04/25/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043708050 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | DN7283 (Florida) | Primary |
| 261QD0000X | Clinic/center - Dental | DN12922 (Florida) | Secondary |
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