Provider Demographics
NPI:1801860358
Name:BUDDE, KEN FRITZ (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEN
Middle Name:FRITZ
Last Name:BUDDE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 180
Mailing Address - Street 2:
Mailing Address - City:KILL DEVIL HILLS
Mailing Address - State:NC
Mailing Address - Zip Code:27948-0180
Mailing Address - Country:US
Mailing Address - Phone:252-441-5811
Mailing Address - Fax:252-441-2233
Practice Address - Street 1:3118 N CROATAN HWY
Practice Address - Street 2:SUITE 102
Practice Address - City:KILL DEVIL HILLS
Practice Address - State:NC
Practice Address - Zip Code:27948-9254
Practice Address - Country:US
Practice Address - Phone:252-441-5811
Practice Address - Fax:252-441-2233
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC54331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice