Provider Demographics
NPI:1063524551
Name:JAMES, KENNETH
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:JAMES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07063-1000
Mailing Address - Country:US
Mailing Address - Phone:908-753-6401
Mailing Address - Fax:
Practice Address - Street 1:101 LUDLOW ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07114-1108
Practice Address - Country:US
Practice Address - Phone:973-565-0355
Practice Address - Fax:973-565-0461
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D102154500122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1194996645Other444 WILLIAM STREET
NJ1740345693Other741 BROADWAY
NJ1972778413Other1150 SPRINGFIELD AVE
NJ8727309Medicaid
NJ8727309Medicaid
NJ1972778413Other1150 SPRINGFIELD AVE