Provider Demographics
NPI:1346341641
Name:MARZ, KENNETH JOHN (DDS)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:JOHN
Last Name:MARZ
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 1:918 FORT UNION BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-1714
Mailing Address - Country:US
Mailing Address - Phone:801-304-9391
Mailing Address - Fax:801-304-9398
Practice Address - Street 1:918 FORT UNION BLVD
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-1714
Practice Address - Country:US
Practice Address - Phone:801-304-9391
Practice Address - Fax:801-304-9398
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT275551-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist