Provider Demographics
NPI:1760449359
Name:ZUCKER, KENNETH J (DDS,MS)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:J
Last Name:ZUCKER
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4640 NICOLS RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-2306
Mailing Address - Country:US
Mailing Address - Phone:651-994-1344
Mailing Address - Fax:651-994-1343
Practice Address - Street 1:4640 NICOLS RD
Practice Address - Street 2:SUITE 202
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2306
Practice Address - Country:US
Practice Address - Phone:651-994-1344
Practice Address - Fax:651-994-1343
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN86211223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics