Provider Demographics
NPI:1235385584
Name:KENNETH T KMIECK
Entity Type:Organization
Organization Name:KENNETH T KMIECK
Other - Org Name:DENTURE SOLUTIONS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:KMIECK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-343-4172
Mailing Address - Street 1:5615 OVERLOOK RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-2453
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5615 OVERLOOK RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-2453
Practice Address - Country:US
Practice Address - Phone:440-343-4172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty