Provider Demographics
NPI:1114452455
Name:DIMINICK, KENNETH J (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:J
Last Name:DIMINICK
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3412 TRINDLE RD
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-4418
Mailing Address - Country:US
Mailing Address - Phone:717-503-7396
Mailing Address - Fax:717-975-8790
Practice Address - Street 1:3412 TRINDLE RD
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-4418
Practice Address - Country:US
Practice Address - Phone:717-503-7396
Practice Address - Fax:717-975-8790
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS022703L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist