Provider Demographics
NPI:1780196329
Name:PAUL KENWORTHY DMD, PC
Entity Type:Organization
Organization Name:PAUL KENWORTHY DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:KENWORTHY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:802-238-7249
Mailing Address - Street 1:1 KENNEDY DR # LL4
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-7152
Mailing Address - Country:US
Mailing Address - Phone:802-318-6944
Mailing Address - Fax:888-965-5114
Practice Address - Street 1:1 KENNEDY DR # LL4
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-7152
Practice Address - Country:US
Practice Address - Phone:888-720-5832
Practice Address - Fax:888-965-5114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment