Kevin Shan, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN27074 Issued in FL

Practice address

4730 W State Road 46 Ste 1220
Sanford, FL 32771-9343

Phone

(407) 708-3145

NPI assigned

Mar 26, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dentists of Sanford PA

  dba Dentists of Sanford

  • General Practice Dentistry
  • Sanford, FL
  • NPI 1801455787
  NPD (past)
• Mount Dora Modern Dentistry, PA

  dba Mount Dora Modern Dentistry

  • General Practice Dentistry
  • Eustis, FL
  • NPI 1659815306
  NPD (past)

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

{
    "created_epoch": "1648252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712707200000",
    "number": "1326798976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17365 US HIGHWAY 441",
            "city": "MOUNT DORA",
            "state": "FL",
            "postal_code": "327576715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4730 W STATE ROAD 46 STE 1220",
            "city": "SANFORD",
            "state": "FL",
            "postal_code": "327719343",
            "telephone_number": "407-708-3145"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17365 US Highway 441",
            "address_purpose": "LOCATION",
            "city": "Mount Dora",
            "state": "FL",
            "postal_code": "327576715",
            "country_code": "US",
            "telephone_number": "352-270-3015",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAN",
        "first_name": "KEVIN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-26",
        "last_updated": "2024-04-10",
        "certification_date": "2024-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN27074",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leidee Karenna Senors, M.D.
• Jacqueline Seoane, MD
• Serene Minds Wellness LLC
• Erica H Serito
• Marian J Servidio, RN
• Karen Michelle Shannon
• Shilpa Patil Sharma, PT, PHD
• Erilda Shehu
• Clayton Shell
• Renee Shell, ARNP

• General Practice Dentistry in Sanford, FL
• Providers in Sanford, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2024; 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.