Provider Demographics
NPI:1023909686
Name:MCKELVIE, KENNETH GRAEME (DDS)
Entity type:Individual
Prefix:DR
First Name:KENNETH GRAEME
Middle Name:
Last Name:MCKELVIE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 EAGLE NEST DR
Mailing Address - Street 2:
Mailing Address - City:OAKLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94561-6044
Mailing Address - Country:US
Mailing Address - Phone:619-399-6824
Mailing Address - Fax:
Practice Address - Street 1:3453 BROOKSIDE RD
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-1772
Practice Address - Country:US
Practice Address - Phone:209-955-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-11
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111662122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist