Provider Demographics
NPI:1033282439
Name:SCHNEIDER, KENNETH MARTIN JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:MARTIN
Last Name:SCHNEIDER
Suffix:JR
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:PO BOX 1322
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-1322
Mailing Address - Country:US
Mailing Address - Phone:704-895-3320
Mailing Address - Fax:704-895-3321
Practice Address - Street 1:20905 TORRENCE CHAPEL RD
Practice Address - Street 2:STE. 201
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-4300
Practice Address - Country:US
Practice Address - Phone:704-895-3320
Practice Address - Fax:704-895-3321
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC66351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice