Provider Demographics
NPI:1124293048
Name:KENNETH J. KIEFT DDS PC
Entity type:Organization
Organization Name:KENNETH J. KIEFT DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:KIEFT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:269-465-3001
Mailing Address - Street 1:9500 RED ARROW HWY
Mailing Address - Street 2:P.O. BOX 769
Mailing Address - City:BRIDGMAN
Mailing Address - State:MI
Mailing Address - Zip Code:49106-9593
Mailing Address - Country:US
Mailing Address - Phone:269-465-3001
Mailing Address - Fax:269-465-3001
Practice Address - Street 1:9500 RED ARROW HWY
Practice Address - Street 2:
Practice Address - City:BRIDGMAN
Practice Address - State:MI
Practice Address - Zip Code:49106-9593
Practice Address - Country:US
Practice Address - Phone:269-465-3001
Practice Address - Fax:269-465-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010092431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty