Provider Demographics
NPI:1477515104
Name:DUNSTON, KENNETH R (DDS, MSD, PC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:R
Last Name:DUNSTON
Suffix:
Gender:M
Credentials:DDS, MSD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 N BUTLER AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-4201
Mailing Address - Country:US
Mailing Address - Phone:505-327-5057
Mailing Address - Fax:505-327-0330
Practice Address - Street 1:2050 N BUTLER AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-4201
Practice Address - Country:US
Practice Address - Phone:505-327-5057
Practice Address - Fax:505-327-0330
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM9911223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM007350Medicaid
NMB8178Medicaid