Provider Demographics
NPI:1144386004
Name:KRAM, KENNETH E (DMD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:E
Last Name:KRAM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:456 N NEW BALLAS RD
Mailing Address - Street 2:SUITE 249
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6831
Mailing Address - Country:US
Mailing Address - Phone:314-569-2201
Mailing Address - Fax:314-569-2320
Practice Address - Street 1:456 N NEW BALLAS RD STE 249
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6842
Practice Address - Country:US
Practice Address - Phone:314-569-2201
Practice Address - Fax:314-569-2320
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO135601223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO111520OtherCIGNA HMO
MO29086OtherBCBS
MOT70963Medicare ID - Type UnspecifiedMEDICARE