Provider Demographics
NPI:1225179096
Name:DOBSON, KENNETH C (DMD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:C
Last Name:DOBSON
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 1:10261A CLEMSON BLVD
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678-0816
Mailing Address - Country:US
Mailing Address - Phone:864-888-3102
Mailing Address - Fax:864-888-3124
Practice Address - Street 1:10261A CLEMSON BLVD
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-0816
Practice Address - Country:US
Practice Address - Phone:864-888-3102
Practice Address - Fax:864-888-3124
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2486122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist