Provider Demographics
NPI:1518940287
Name:BALMFORTH, KENNETH R (DMD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:R
Last Name:BALMFORTH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 SW ALDER ST
Mailing Address - Street 2:SUITE 901
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-3625
Mailing Address - Country:US
Mailing Address - Phone:503-227-1491
Mailing Address - Fax:
Practice Address - Street 1:610 SW ALDER ST
Practice Address - Street 2:SUITE 901
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-3625
Practice Address - Country:US
Practice Address - Phone:503-227-1491
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD44091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice