Provider Demographics
NPI:1265988620
Name:KENWORTHY DENTAL CORP
Entity type:Organization
Organization Name:KENWORTHY DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNEE
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:KENWORTHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-780-3900
Mailing Address - Street 1:730 SUNRISE AVE
Mailing Address - Street 2:STE 140
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4567
Mailing Address - Country:US
Mailing Address - Phone:916-780-3900
Mailing Address - Fax:
Practice Address - Street 1:730 SUNRISE AVE
Practice Address - Street 2:STE 140
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4567
Practice Address - Country:US
Practice Address - Phone:916-780-3900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-26
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty