Provider Demographics
NPI:1114305992
Name:TANEN, KENNETH (DDS)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:TANEN
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:PO BOX 122
Mailing Address - Street 2:
Mailing Address - City:BROWNS MILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:08015-0122
Mailing Address - Country:US
Mailing Address - Phone:609-893-2366
Mailing Address - Fax:
Practice Address - Street 1:100 PEMBERTON BROWNS MILL RD
Practice Address - Street 2:
Practice Address - City:BROWNS MILLS
Practice Address - State:NJ
Practice Address - Zip Code:08015-3127
Practice Address - Country:US
Practice Address - Phone:609-893-2366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02341600122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist