Provider Demographics
NPI:1821417361
Name:NEGRO, KENNETH SAWYER (DDS, MS)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:SAWYER
Last Name:NEGRO
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 J ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-2913
Mailing Address - Country:US
Mailing Address - Phone:360-676-7130
Mailing Address - Fax:360-676-1125
Practice Address - Street 1:1301 J ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-2913
Practice Address - Country:US
Practice Address - Phone:360-676-7130
Practice Address - Fax:360-676-1125
Is Sole Proprietor?:No
Enumeration Date:2014-04-14
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WADE 605367471223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program