Provider Demographics
NPI:1639801558
Name:KE, VICTOR J (DMD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:J
Last Name:KE
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 1:4970 EBENSBURG DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-1382
Mailing Address - Country:US
Mailing Address - Phone:813-810-2869
Mailing Address - Fax:
Practice Address - Street 1:7255 KATHLEEN RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33810-4722
Practice Address - Country:US
Practice Address - Phone:863-274-3410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL27135122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist