Provider Demographics
NPI:1699967901
Name:SMITH, KENNETH DEAN (DDS)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:DEAN
Last Name:SMITH
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 1:516 W REMINGTON DR
Mailing Address - Street 2:#4-B
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-2470
Mailing Address - Country:US
Mailing Address - Phone:408-736-5498
Mailing Address - Fax:
Practice Address - Street 1:516 W REMINGTON DR
Practice Address - Street 2:#4-B
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-2470
Practice Address - Country:US
Practice Address - Phone:408-736-5498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA364541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice