Provider Demographics
NPI:1639266604
Name:SPRINGER, KENNETH WARREN (DMD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:WARREN
Last Name:SPRINGER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 N NASHVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35660-2940
Mailing Address - Country:US
Mailing Address - Phone:256-383-4171
Mailing Address - Fax:
Practice Address - Street 1:518 N NASHVILLE AVE
Practice Address - Street 2:
Practice Address - City:SHEFFIELD
Practice Address - State:AL
Practice Address - Zip Code:35660-2940
Practice Address - Country:US
Practice Address - Phone:256-383-4171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL42611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice