Provider Demographics
NPI:1427160175
Name:DIDAT, KENNETH ELMER (DDS)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:ELMER
Last Name:DIDAT
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 1:3007 CHARLESTOWN XING
Mailing Address - Street 2:SUITE #100
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-9484
Mailing Address - Country:US
Mailing Address - Phone:812-945-3829
Mailing Address - Fax:812-945-3722
Practice Address - Street 1:3007 CHARLESTOWN XING
Practice Address - Street 2:SUITE #100
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-9484
Practice Address - Country:US
Practice Address - Phone:812-945-3829
Practice Address - Fax:812-945-3722
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008781122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist