Provider Demographics
NPI:1891000154
Name:DYER, KENNETH C IV (DDS, MDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:C
Last Name:DYER
Suffix:IV
Gender:M
Credentials:DDS, MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4610 BRAINERD RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-3835
Mailing Address - Country:US
Mailing Address - Phone:423-624-6525
Mailing Address - Fax:423-629-9889
Practice Address - Street 1:4610 BRAINERD RD
Practice Address - Street 2:SUITE 3
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-3835
Practice Address - Country:US
Practice Address - Phone:423-624-6525
Practice Address - Fax:423-629-9889
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS91491223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics