Provider Demographics
NPI:1265440507
Name:DR. KENNETH E. ALFORTISH LTD.
Entity type:Organization
Organization Name:DR. KENNETH E. ALFORTISH LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:ALFORTISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-368-2792
Mailing Address - Street 1:517 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056
Mailing Address - Country:US
Mailing Address - Phone:504-368-2792
Mailing Address - Fax:504-368-2827
Practice Address - Street 1:517 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056
Practice Address - Country:US
Practice Address - Phone:504-368-2792
Practice Address - Fax:504-368-2827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty