Provider Demographics
NPI:1558574103
Name:ZHAO, KENNETH C (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:C
Last Name:ZHAO
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 1:751 ROCKVILLE PIKE
Mailing Address - Street 2:SUITE 15A
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-1129
Mailing Address - Country:US
Mailing Address - Phone:301-838-0812
Mailing Address - Fax:301-838-0813
Practice Address - Street 1:751 ROCKVILLE PIKE
Practice Address - Street 2:SUITE 15A
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1129
Practice Address - Country:US
Practice Address - Phone:301-838-0812
Practice Address - Fax:301-838-0813
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD111821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice