Provider Demographics
NPI:1033197090
Name:KENNETH L WILLIAMS D.D.S. P.A.
Entity Type:Organization
Organization Name:KENNETH L WILLIAMS D.D.S. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:620-431-3000
Mailing Address - Street 1:2607 S SANTA FE AVE
Mailing Address - Street 2:
Mailing Address - City:CHANUTE
Mailing Address - State:KS
Mailing Address - Zip Code:66720-3206
Mailing Address - Country:US
Mailing Address - Phone:620-431-3000
Mailing Address - Fax:620-431-6122
Practice Address - Street 1:2607 S SANTA FE AVE
Practice Address - Street 2:
Practice Address - City:CHANUTE
Practice Address - State:KS
Practice Address - Zip Code:66720-3206
Practice Address - Country:US
Practice Address - Phone:620-431-3000
Practice Address - Fax:620-431-6122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-09
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS60931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100222900-AMedicaid
KS8522OtherBC/BS PROVIDER #