Provider Demographics
NPI:1467510974
Name:SWENSON, KENNETH A (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:A
Last Name:SWENSON
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 1:401 GREGORY LN
Mailing Address - Street 2:SUITE 142
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-2800
Mailing Address - Country:US
Mailing Address - Phone:925-689-7122
Mailing Address - Fax:
Practice Address - Street 1:401 GREGORY LN
Practice Address - Street 2:SUITE 142
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-2800
Practice Address - Country:US
Practice Address - Phone:925-689-7122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA195361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice