Provider Demographics
NPI:1801011911
Name:KENNETH C. FORDHAM, JR.
Entity Type:Organization
Organization Name:KENNETH C. FORDHAM, JR.
Other - Org Name:CHESTER SPRINGS FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:FORDHAM
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-458-3800
Mailing Address - Street 1:241 BYERS RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER SPRINGS
Mailing Address - State:PA
Mailing Address - Zip Code:19425
Mailing Address - Country:US
Mailing Address - Phone:610-458-3800
Mailing Address - Fax:610-458-3904
Practice Address - Street 1:241 BYERS RD
Practice Address - Street 2:
Practice Address - City:CHESTER SPRINGS
Practice Address - State:PA
Practice Address - Zip Code:19425
Practice Address - Country:US
Practice Address - Phone:610-458-3800
Practice Address - Fax:610-458-3904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS023116L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty