Kevin James Distefano, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

30017328 Issued in OH

Practice address

5868 N High St
Worthington, OH 43085-4183

Phone

(614) 885-8191

NPI assigned

Jan 5, 2006

Sex

Male

Sole proprietor

Yes

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": "1136419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1257811200000",
    "number": "1972581395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5868 N HIGH ST",
            "city": "WORTHINGTON",
            "state": "OH",
            "postal_code": "430854183",
            "telephone_number": "614-885-8191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5868 N HIGH ST",
            "city": "WORTHINGTON",
            "state": "OH",
            "postal_code": "430854183",
            "telephone_number": "614-885-8191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DISTEFANO",
        "first_name": "KEVIN",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-05",
        "last_updated": "2009-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30017328",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marie Nancy Dilauro, M.D.
• Shufeng Ding, ACUPUNCTURIST
• Nicholas Dioguardi
• Directions Counseling Group, Inc.
• Kelly Marie Distefano, DMD
• Rachel M Dixon, LSW
• Marciana Dobson
• Natese Dockery
• Jesseca Doherty
• Kara Dolan

• General Practice Dentistry in Worthington, OH
• Providers in Worthington, OH by specialty
• General Practice Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2009; 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.