Provider Demographics
NPI:1093876856
Name:KENNETH A. YORGEY DMD PA
Entity Type:Organization
Organization Name:KENNETH A. YORGEY DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:YORGEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-654-0029
Mailing Address - Street 1:133 JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-9234
Mailing Address - Country:US
Mailing Address - Phone:609-654-0029
Mailing Address - Fax:609-714-0159
Practice Address - Street 1:133 JACKSON RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-9234
Practice Address - Country:US
Practice Address - Phone:609-654-0029
Practice Address - Fax:609-714-0159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ11729261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental