Provider Demographics
NPI:1588743744
Name:KEHL, KENNETH A (DDS)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:A
Last Name:KEHL
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 1:12760 S HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-2171
Mailing Address - Country:US
Mailing Address - Phone:708-361-0577
Mailing Address - Fax:708-361-8394
Practice Address - Street 1:12760 S HARLEM AVE
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-2171
Practice Address - Country:US
Practice Address - Phone:708-361-0577
Practice Address - Fax:708-361-8394
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice