Provider Demographics
NPI:1689733685
Name:DO, KENT NAM (DMD)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:NAM
Last Name:DO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:NAM
Other - Middle Name:B
Other - Last Name:DO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:17564 SANTA CATALINA CIR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4309
Mailing Address - Country:US
Mailing Address - Phone:714-376-3770
Mailing Address - Fax:
Practice Address - Street 1:3500 S BRISTOL ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-7319
Practice Address - Country:US
Practice Address - Phone:714-957-6030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA519181223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry