Provider Demographics
NPI:1841321981
Name:ZOUHARY, KENNETH JOHN (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:JOHN
Last Name:ZOUHARY
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2971 CORPORATE PARK DR
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-7283
Mailing Address - Country:US
Mailing Address - Phone:334-749-3436
Mailing Address - Fax:334-749-3223
Practice Address - Street 1:2971 CORPORATE PARK DR
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-7283
Practice Address - Country:US
Practice Address - Phone:334-749-3436
Practice Address - Fax:334-749-3223
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL53021223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009939024Medicaid
AL515-36541OtherBCBS