Provider Demographics
NPI:1609030642
Name:NASH, KENNETH DAVID (DDS)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:DAVID
Last Name:NASH
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 1:1201 MISSION PARK DR
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39180-3747
Mailing Address - Country:US
Mailing Address - Phone:601-634-1812
Mailing Address - Fax:601-630-9559
Practice Address - Street 1:1201 MISSION PARK DR
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-3747
Practice Address - Country:US
Practice Address - Phone:601-634-1812
Practice Address - Fax:601-630-9559
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS23541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice