Provider Demographics
NPI:1659540326
Name:KAIS, KENNETH K (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:K
Last Name:KAIS
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 1:1101 YAKIMA AVE
Mailing Address - Street 2:DENTURIST PROGRAM
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4831
Mailing Address - Country:US
Mailing Address - Phone:253-680-7314
Mailing Address - Fax:
Practice Address - Street 1:1101 YAKIMA AVE
Practice Address - Street 2:DENTURIST PROGRAM
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4831
Practice Address - Country:US
Practice Address - Phone:253-680-7314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA80381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice