Provider Demographics
NPI:1174742803
Name:KENCOS-HAJEK, ANNE L (DDS)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:L
Last Name:KENCOS-HAJEK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7485 CONROY WINDERMERE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-2767
Mailing Address - Country:US
Mailing Address - Phone:407-532-1977
Mailing Address - Fax:407-532-1916
Practice Address - Street 1:7485 CONROY WINDERMERE RD
Practice Address - Street 2:SUITE B
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-2767
Practice Address - Country:US
Practice Address - Phone:407-532-1977
Practice Address - Fax:407-532-1916
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN147521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice