Provider Demographics
NPI:1376654715
Name:DANYLUK, KENNETH ERNEST (DMD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ERNEST
Last Name:DANYLUK
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 1:16638 S MOUNTAIN STONE TRL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-2081
Mailing Address - Country:US
Mailing Address - Phone:480-759-3333
Mailing Address - Fax:
Practice Address - Street 1:4350 E RAY RD STE 121 BLDG 4
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-4705
Practice Address - Country:US
Practice Address - Phone:480-759-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ53461223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics