Provider Demographics
NPI:1003914607
Name:FERENTCHAK, KENNETH PAUL (DDS)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:PAUL
Last Name:FERENTCHAK
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 1:1011 N MAYFAIR RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3431
Mailing Address - Country:US
Mailing Address - Phone:414-771-4480
Mailing Address - Fax:414-771-8862
Practice Address - Street 1:1011 N MAYFAIR RD
Practice Address - Street 2:SUITE 303
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-3431
Practice Address - Country:US
Practice Address - Phone:414-771-4480
Practice Address - Fax:414-771-8862
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI40391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice