Provider Demographics
NPI:1578720405
Name:ZACHMANN, KENNETH L (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:L
Last Name:ZACHMANN
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 1:52 COCHITUATE RD
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-2607
Mailing Address - Country:US
Mailing Address - Phone:508-358-2091
Mailing Address - Fax:
Practice Address - Street 1:52 COCHITUATE RD
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778-2607
Practice Address - Country:US
Practice Address - Phone:508-358-2091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA177741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY52842OtherBLUE CROSS AND BLUE SHIELD