Provider Demographics
NPI:1093885691
Name:MACAFEE, KENNETH A II (DMD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:A
Last Name:MACAFEE
Suffix:II
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:982 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-7404
Mailing Address - Country:US
Mailing Address - Phone:781-899-5660
Mailing Address - Fax:781-893-7027
Practice Address - Street 1:982 MAIN ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-7404
Practice Address - Country:US
Practice Address - Phone:781-899-5660
Practice Address - Fax:781-893-7027
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA185071223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery