Provider Demographics
NPI:1477893246
Name:KENWORTHY, LINDA K (DDS)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:K
Last Name:KENWORTHY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 ASH ST
Mailing Address - Street 2:
Mailing Address - City:WAMEGO
Mailing Address - State:KS
Mailing Address - Zip Code:66547-1713
Mailing Address - Country:US
Mailing Address - Phone:785-456-7872
Mailing Address - Fax:785-456-1651
Practice Address - Street 1:407 ASH ST
Practice Address - Street 2:
Practice Address - City:WAMEGO
Practice Address - State:KS
Practice Address - Zip Code:66547-1713
Practice Address - Country:US
Practice Address - Phone:785-456-7872
Practice Address - Fax:785-456-1651
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-15
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS64211223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health