Provider Demographics
NPI:1053484378
Name:KORPAN, KENNETH A (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:A
Last Name:KORPAN
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 1:6827 CHURCH CT
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-1525
Mailing Address - Country:US
Mailing Address - Phone:630-879-2011
Mailing Address - Fax:630-879-2060
Practice Address - Street 1:239 W WILSON ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-1946
Practice Address - Country:US
Practice Address - Phone:630-879-2011
Practice Address - Fax:630-879-2060
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
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice