Individual
DR. KEVIN SEAN SHORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1200 BALD RIDGE MARINA RD, SUITE 200, CUMMING, GA 30041-8494
(770) 781-8650
(770) 781-2953
Mailing address
PO BOX 599, CUMMING, GA 30028-0599
(770) 781-8650
(770) 781-2953
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN011242
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4080537
BC/BS
TN
01
—
825012
UNITED CONCORDIA
GA
Enumeration date
10/03/2006
Last updated
07/08/2007
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