# KEVIN A DELORIA DDS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245619956
- **Authorized official:** DR. KEVIN A DELORIA DDS (DENTIST)
- **Authorized official phone:** (765) 342-8435

## Contact information

- **Practice address:** 1690 S OHIO ST, MARTINSVILLE, IN 46151-3317
- **Practice address phone:** (765) 342-8435
- **Practice address fax:** (765) 342-3561
- **Mailing address:** 1690 S OHIO ST, MARTINSVILLE, IN 46151-3317
- **Mailing address phone:** (765) 342-8435
- **Mailing address fax:** (765) 342-3561

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 12009312 | IN | Yes |

## Other

- **Enumeration date:** 05/27/2015
- **Last updated:** 05/27/2015