Provider Demographics
NPI:1851491880
Name:KENNETH K WOO PC
Entity Type:Organization
Organization Name:KENNETH K WOO PC
Other - Org Name:SEEKONK DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:K
Authorized Official - Last Name:WOO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:508-336-7755
Mailing Address - Street 1:1563 FALL RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:SEEKONK
Mailing Address - State:MA
Mailing Address - Zip Code:02771
Mailing Address - Country:US
Mailing Address - Phone:508-336-7755
Mailing Address - Fax:508-336-9970
Practice Address - Street 1:1563 FALL RIVER AVE
Practice Address - Street 2:
Practice Address - City:SEEKONK
Practice Address - State:MA
Practice Address - Zip Code:02771
Practice Address - Country:US
Practice Address - Phone:508-336-7755
Practice Address - Fax:508-336-9970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA166231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
190633OtherUNITED CONCORDIA
RI8503-4OtherBLUE CROSS - RI
MAX11529OtherBLUE CROSS - MA
0005993224OtherAETNA
RI16623OtherDELTA DENTAL
14495-1OtherUNITED HEALTH CARE