Provider Demographics
NPI:1609459346
Name:KENNETH HANCOCK DDS, PLLC
Entity Type:Organization
Organization Name:KENNETH HANCOCK DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:L
Authorized Official - Last Name:HANCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-753-7388
Mailing Address - Street 1:1401 4TH AVE E STE 100
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-4484
Mailing Address - Country:US
Mailing Address - Phone:360-753-7388
Mailing Address - Fax:360-753-3553
Practice Address - Street 1:1401 4TH AVE E STE 100
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-4484
Practice Address - Country:US
Practice Address - Phone:360-753-7388
Practice Address - Fax:360-753-3553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122400000XDental ProvidersDenturistGroup - Multi-Specialty