Provider Demographics
NPI:1841554979
Name:ZAMORA, KENNETH (DMD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:ZAMORA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-3709
Mailing Address - Country:US
Mailing Address - Phone:843-818-5437
Mailing Address - Fax:843-725-1594
Practice Address - Street 1:216 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-3709
Practice Address - Country:US
Practice Address - Phone:843-818-5437
Practice Address - Fax:843-725-1594
Is Sole Proprietor?:No
Enumeration Date:2012-07-04
Last Update Date:2012-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD.8104GD1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry