Kevin Melanio Corvacho, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

11375 Issued in TN

Practice address

2854 N Main St Ste 102
Crossville, TN 38555-5413

Phone

(931) 456-1138

NPI assigned

Aug 28, 2020

Last updated

Aug 28, 2020By the provider in NPPES

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

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

{
    "created_epoch": "1598572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598572800000",
    "number": "1467065326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2854 N MAIN ST STE 102",
            "city": "CROSSVILLE",
            "state": "TN",
            "postal_code": "385555413",
            "telephone_number": "931-456-1138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2854 N MAIN ST STE 102",
            "city": "CROSSVILLE",
            "state": "TN",
            "postal_code": "385555413",
            "telephone_number": "931-456-1138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORVACHO",
        "first_name": "KEVIN",
        "middle_name": "MELANIO",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-08-28",
        "last_updated": "2020-08-28",
        "certification_date": "2020-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "11375",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Crossville, TN
• Providers in Crossville, TN by specialty
• General Practice Dentistry in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2020; 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.