Provider Demographics
NPI:1326167750
Name:DOTT, KENNETH WAYNE (DO)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:WAYNE
Last Name:DOTT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 W AIRPORT FWY
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-6016
Mailing Address - Country:US
Mailing Address - Phone:972-258-7838
Mailing Address - Fax:972-255-5819
Practice Address - Street 1:2401 W AIRPORT FWY
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-6016
Practice Address - Country:US
Practice Address - Phone:972-258-7838
Practice Address - Fax:972-255-5819
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8008207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81M242Medicare PIN
TXE70076Medicare UPIN