Provider Demographics
NPI:1619083474
Name:REHDER, KENNETH BURKHARDT (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:BURKHARDT
Last Name:REHDER
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 1:603 HIGHWAY 321 N
Mailing Address - Street 2:
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37771-6575
Mailing Address - Country:US
Mailing Address - Phone:865-986-0842
Mailing Address - Fax:865-986-6459
Practice Address - Street 1:603 HIGHWAY 321 N
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37771-6575
Practice Address - Country:US
Practice Address - Phone:865-986-0842
Practice Address - Fax:865-986-6459
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS76621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice