Provider Demographics
NPI:1407904196
Name:KEN MCAFEE, DMD, PC
Entity Type:Organization
Organization Name:KEN MCAFEE, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MCAFEE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:706-602-9255
Mailing Address - Street 1:127 WC BRYANT PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-2654
Mailing Address - Country:US
Mailing Address - Phone:706-602-9255
Mailing Address - Fax:706-602-9256
Practice Address - Street 1:127 WC BRYANT PKWY STE A
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-2654
Practice Address - Country:US
Practice Address - Phone:706-602-9255
Practice Address - Fax:706-602-9256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA117031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty