Provider Demographics
NPI:1225340532
Name:WEBBER, KENNETH WELLESLEY (DDS)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:WELLESLEY
Last Name:WEBBER
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 1:1809 VERDUGO BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1402
Mailing Address - Country:US
Mailing Address - Phone:818-790-1844
Mailing Address - Fax:818-790-0047
Practice Address - Street 1:1809 VERDUGO BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1402
Practice Address - Country:US
Practice Address - Phone:818-790-1844
Practice Address - Fax:818-790-0047
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-02
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22427122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist