Provider Demographics
NPI:1871683391
Name:GUDZ, KENNETH LLOYD (DMD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:LLOYD
Last Name:GUDZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 OFFICE PARK RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:HILTON HEAD
Mailing Address - State:SC
Mailing Address - Zip Code:29928-4637
Mailing Address - Country:US
Mailing Address - Phone:843-785-4801
Mailing Address - Fax:843-785-7804
Practice Address - Street 1:32 OFFICE PARK RD
Practice Address - Street 2:SUITE 207
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29928-4637
Practice Address - Country:US
Practice Address - Phone:843-785-4801
Practice Address - Fax:843-785-7804
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC33191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice