Provider Demographics
NPI:1225171465
Name:THORELL, KENNETH ROY (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ROY
Last Name:THORELL
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 1:4970 S 900 E STE B
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-5798
Mailing Address - Country:US
Mailing Address - Phone:801-261-2013
Mailing Address - Fax:801-262-2851
Practice Address - Street 1:4970 S 900 E STE B
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-5798
Practice Address - Country:US
Practice Address - Phone:801-261-2013
Practice Address - Fax:801-262-2851
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT134987-99211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice