Provider Demographics
NPI:1710178538
Name:CAREY, KENNETH (DMD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:CAREY
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 1:516 W 39TH ST STE D
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-2881
Mailing Address - Country:US
Mailing Address - Phone:308-865-2577
Mailing Address - Fax:308-234-9526
Practice Address - Street 1:516 W 39TH ST STE D
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-2881
Practice Address - Country:US
Practice Address - Phone:308-865-2577
Practice Address - Fax:308-234-9526
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-4096122300000X
NE75171223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist