Provider Demographics
NPI:1376893370
Name:KENNETH G. BILLS D.D.S. P.C.
Entity Type:Organization
Organization Name:KENNETH G. BILLS D.D.S. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:BILLS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-277-0090
Mailing Address - Street 1:2180 E 4500 S
Mailing Address - Street 2:SUITE 240
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-4434
Mailing Address - Country:US
Mailing Address - Phone:801-277-0090
Mailing Address - Fax:801-277-0092
Practice Address - Street 1:2180 E 4500 S
Practice Address - Street 2:SUITE 240
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-4434
Practice Address - Country:US
Practice Address - Phone:801-277-0090
Practice Address - Fax:801-277-0092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2213870299221223G0001X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty