Provider Demographics
NPI:1144243643
Name:GOULD, KENNETH LIARD III (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:LIARD
Last Name:GOULD
Suffix:III
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 1:1831 S GREENBAY RD
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53406-4605
Mailing Address - Country:US
Mailing Address - Phone:262-633-0080
Mailing Address - Fax:262-619-0311
Practice Address - Street 1:1831 S GREENBAY RD
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-4605
Practice Address - Country:US
Practice Address - Phone:262-633-0080
Practice Address - Fax:262-619-0311
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5805-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice