Provider Demographics
NPI:1821349648
Name:SINGLETON, KENNETH S (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:S
Last Name:SINGLETON
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 1:624 HARRIS ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-4448
Mailing Address - Country:US
Mailing Address - Phone:707-442-5739
Mailing Address - Fax:707-442-9013
Practice Address - Street 1:624 HARRIS ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-4448
Practice Address - Country:US
Practice Address - Phone:707-442-5739
Practice Address - Fax:707-442-9013
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA252161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice