Kevin G. Eubanks, D.M.D

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

3587 Issued in SC

Legal business name

KEVIN G. EUBANKS, D.M.D

Practice address

174 Crepe Myrtle Drive
Aiken, SC 29803

Phone

(803) 641-3883

NPI assigned

Sep 6, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Kelli Gray

Title

Business Coordinator

Phone

(803) 641-3883

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Southern Dental Associates Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Matthew Tyler Wall, DMD

  • General Practice Dentistry
  • Aiken, SC
  • NPI 1083247209
  NPD (past)
• Trent David Yoder, DMD

  • General Practice Dentistry
  • Metamora, IL
  • NPI 1689197691
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1504656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1504656000000",
    "number": "1013435429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "174 CREPE MYRTLE DRIVE",
            "city": "AIKEN",
            "state": "SC",
            "postal_code": "29803",
            "telephone_number": "803-641-3883",
            "fax_number": "803-641-3198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "174 CREPE MYRTLE DRIVE",
            "city": "AIKEN",
            "state": "SC",
            "postal_code": "29803",
            "telephone_number": "803-641-3883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEVIN G. EUBANKS, D.M.D",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-06",
        "last_updated": "2017-09-06",
        "status": "A",
        "authorized_official_last_name": "GRAY",
        "authorized_official_first_name": "KELLI",
        "authorized_official_title_or_position": "BUSINESS COORDINATOR",
        "authorized_official_telephone_number": "803-641-3883",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "SC",
            "license": "3587",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SOUTH CAROLINA BOARD",
            "identifier": "3587",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Dental Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ashlyn Christine Kelly, PA-C
• Moesha Ikia Kendrick, MSW
• Ebony Bates Kerlin, PA-C
• April J Kerr, LISW-CP
• Denise Kay Kessinger
• Azeem Khalid, M.D.
• Majid Khan
• Misbba Khan, MD
• Wardah Javed Khan, MD
• Vibhuti Khatri, M.D.

• Dental Clinic/Center in Aiken, SC
• Providers in Aiken, SC by specialty
• Dental Clinic/Center in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.