Provider Demographics
NPI:1598909467
Name:KENNETH C. DOBSON DMD INC.
Entity Type:Organization
Organization Name:KENNETH C. DOBSON DMD INC.
Other - Org Name:KEOWEE SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:DOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:864-888-3102
Mailing Address - Street 1:241 STORK WAY
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678-1039
Mailing Address - Country:US
Mailing Address - Phone:864-888-3102
Mailing Address - Fax:864-888-3124
Practice Address - Street 1:241 STORK WAY
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-1039
Practice Address - Country:US
Practice Address - Phone:864-888-3102
Practice Address - Fax:864-888-3124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-23
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24861223G0001X
SC15851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty