Provider Demographics
NPI:1134295397
Name:DUPREE, KENNETH REID (D M D)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:REID
Last Name:DUPREE
Suffix:
Gender:M
Credentials:D M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 DEER VALLEY RD
Mailing Address - Street 2:SUITE 1-E
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-7429
Mailing Address - Country:US
Mailing Address - Phone:925-755-1100
Mailing Address - Fax:
Practice Address - Street 1:5201 DEER VALLEY RD
Practice Address - Street 2:SUITE 1-E
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-7429
Practice Address - Country:US
Practice Address - Phone:925-755-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice