Provider Demographics
NPI:1215154901
Name:KENNETH ZHAO, DDS, PA
Entity type:Organization
Organization Name:KENNETH ZHAO, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:ZHAO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-838-0812
Mailing Address - Street 1:751 ROCKVILLE PIKE
Mailing Address - Street 2:SUITE 15A
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-1129
Mailing Address - Country:US
Mailing Address - Phone:301-838-0812
Mailing Address - Fax:301-838-0813
Practice Address - Street 1:751 ROCKVILLE PIKE
Practice Address - Street 2:SUITE 15A
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1129
Practice Address - Country:US
Practice Address - Phone:301-838-0812
Practice Address - Fax:301-838-0813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11182122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty