Provider Demographics
NPI:1174619258
Name:STANIFER, KENNETH CHARLES (DDS)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:CHARLES
Last Name:STANIFER
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 1:233 KING AVE
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-6642
Mailing Address - Country:US
Mailing Address - Phone:423-586-1242
Mailing Address - Fax:423-586-1484
Practice Address - Street 1:233 KING AVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-6642
Practice Address - Country:US
Practice Address - Phone:423-586-1242
Practice Address - Fax:423-586-1484
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS51901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice