Provider Demographics
NPI:1326125782
Name:POWELL, KENNETH SENIOR II (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:SENIOR
Last Name:POWELL
Suffix:II
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 1:3403 UNION BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63115-1127
Mailing Address - Country:US
Mailing Address - Phone:314-381-1556
Mailing Address - Fax:314-381-4599
Practice Address - Street 1:3403 UNION BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63115-1127
Practice Address - Country:US
Practice Address - Phone:314-381-1556
Practice Address - Fax:314-381-4599
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0119871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice