Provider Demographics
NPI:1396070116
Name:K AND N DENTAL GROUP
Entity type:Organization
Organization Name:K AND N DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HAMPTON
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:864-576-7169
Mailing Address - Street 1:125 POWELL MILL RD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-1589
Mailing Address - Country:US
Mailing Address - Phone:864-574-0788
Mailing Address - Fax:864-576-5359
Practice Address - Street 1:125 POWELL MILL RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-1589
Practice Address - Country:US
Practice Address - Phone:864-574-0788
Practice Address - Fax:864-576-5359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-13
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37831223G0001X
SC33131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZA9626Medicaid