Provider Demographics
NPI:1821123480
Name:PARRISH, KENNETH DWAYNE (DMD PHD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:DWAYNE
Last Name:PARRISH
Suffix:
Gender:M
Credentials:DMD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 N MULBERRY ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-3612
Mailing Address - Country:US
Mailing Address - Phone:270-766-1300
Mailing Address - Fax:270-763-1390
Practice Address - Street 1:950 N MULBERRY ST
Practice Address - Street 2:SUITE 250
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-3612
Practice Address - Country:US
Practice Address - Phone:270-766-1300
Practice Address - Fax:270-763-1390
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY66061223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics