Provider Demographics
NPI:1386979847
Name:KENNETH E. NIEMI, D.D.S., P.C.
Entity type:Organization
Organization Name:KENNETH E. NIEMI, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:E
Authorized Official - Last Name:NIEMI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:586-727-0990
Mailing Address - Street 1:68720 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:MI
Mailing Address - Zip Code:48062-1295
Mailing Address - Country:US
Mailing Address - Phone:586-727-0990
Mailing Address - Fax:586-727-4872
Practice Address - Street 1:68720 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MI
Practice Address - Zip Code:48062-1295
Practice Address - Country:US
Practice Address - Phone:586-727-0990
Practice Address - Fax:586-727-4872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901010351261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental