Provider Demographics
NPI:1578714655
Name:KIASER, KENTON EARL (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENTON
Middle Name:EARL
Last Name:KIASER
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 1:9620 ELK GROVE FLORIN RD
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-2226
Mailing Address - Country:US
Mailing Address - Phone:916-685-2260
Mailing Address - Fax:916-685-8698
Practice Address - Street 1:9620 ELK GROVE FLORIN RD
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-2226
Practice Address - Country:US
Practice Address - Phone:916-685-2260
Practice Address - Fax:916-685-8698
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA297651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice