Provider Demographics
NPI:1689077547
Name:YOST, KENNETH JEFFREY (DMD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:JEFFREY
Last Name:YOST
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 1:1407 FOULK RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-2762
Mailing Address - Country:US
Mailing Address - Phone:302-477-1888
Mailing Address - Fax:302-477-1845
Practice Address - Street 1:1407 FOULK RD
Practice Address - Street 2:SUITE 202
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-2762
Practice Address - Country:US
Practice Address - Phone:302-477-1888
Practice Address - Fax:302-477-1845
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-06
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-00000989122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist