Provider Demographics
NPI:1073739405
Name:SJOREN, KENNETH G (DDS)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:G
Last Name:SJOREN
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 1:1090 W HERMISTON AVE
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-1583
Mailing Address - Country:US
Mailing Address - Phone:541-567-7118
Mailing Address - Fax:541-564-9040
Practice Address - Street 1:1090 W HERMISTON AVE
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-1583
Practice Address - Country:US
Practice Address - Phone:541-567-7118
Practice Address - Fax:541-564-9040
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD50981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice