Provider Demographics
NPI:1144200908
Name:THOMAS, KENNETH DELWYN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:DELWYN
Last Name:THOMAS
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 1:6080 DIXIE HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-3493
Mailing Address - Country:US
Mailing Address - Phone:248-623-4990
Mailing Address - Fax:248-623-5914
Practice Address - Street 1:6080 DIXIE HWY
Practice Address - Street 2:SUITE A
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-3493
Practice Address - Country:US
Practice Address - Phone:248-623-4990
Practice Address - Fax:248-623-5914
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI13936122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist