Provider Demographics
NPI:1407968613
Name:THOMASES, KENNETH B (DMD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:B
Last Name:THOMASES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:KEN
Other - Middle Name:
Other - Last Name:THOMASES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:1203 BEACON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5325
Mailing Address - Country:US
Mailing Address - Phone:617-232-8113
Mailing Address - Fax:617-232-1795
Practice Address - Street 1:1203 BEACON ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5325
Practice Address - Country:US
Practice Address - Phone:617-232-8113
Practice Address - Fax:617-232-1795
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA116911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice