Provider Demographics
NPI:1407118391
Name:WARDEN, KENNETH COREY (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:COREY
Last Name:WARDEN
Suffix:
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 1:631 COPELAND MILL RD STE A
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-8905
Mailing Address - Country:US
Mailing Address - Phone:614-899-9200
Mailing Address - Fax:
Practice Address - Street 1:631 COPELAND MILL RD STE A
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8905
Practice Address - Country:US
Practice Address - Phone:614-899-9200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0237691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice