Provider Demographics
NPI:1457469116
Name:CLORE, KENNETH ROGERS (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ROGERS
Last Name:CLORE
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 1:261 BRINKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BROOKEVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20833-2305
Mailing Address - Country:US
Mailing Address - Phone:301-774-4371
Mailing Address - Fax:301-774-3162
Practice Address - Street 1:9801 GEORGIA AVE
Practice Address - Street 2:SUITE 225
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-5276
Practice Address - Country:US
Practice Address - Phone:301-681-9111
Practice Address - Fax:301-681-9112
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD 5352122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist