Provider Demographics
NPI:1205353109
Name:ROBLES GONZALEZ, KENNY ALEJANDRO (DDS)
Entity type:Individual
Prefix:
First Name:KENNY
Middle Name:ALEJANDRO
Last Name:ROBLES GONZALEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3253 S HARLEM AVE
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402
Mailing Address - Country:US
Mailing Address - Phone:323-637-2601
Mailing Address - Fax:
Practice Address - Street 1:3253 S HARLEM AVE
Practice Address - Street 2:SUITE 1C
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402
Practice Address - Country:US
Practice Address - Phone:708-788-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-23
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019031362122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist