Provider Demographics
NPI:1992707152
Name:GEWANT, KENNETH MARC (DMD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:MARC
Last Name:GEWANT
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 1:20 BUCKNELL DR
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-1802
Mailing Address - Country:US
Mailing Address - Phone:516-376-5442
Mailing Address - Fax:
Practice Address - Street 1:20 BUCKNELL DR
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-1802
Practice Address - Country:US
Practice Address - Phone:516-376-5442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0361021223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics