Provider Demographics
NPI:1548427925
Name:WAY, KENNETH C (DMD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:C
Last Name:WAY
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 1:901 RUSSELL AVE
Mailing Address - Street 2:SUIT 410
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-3281
Mailing Address - Country:US
Mailing Address - Phone:301-212-9888
Mailing Address - Fax:
Practice Address - Street 1:901 RUSSELL AVE
Practice Address - Street 2:SUIT 410
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3281
Practice Address - Country:US
Practice Address - Phone:301-212-9888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD104281223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics