Provider Demographics
NPI:1891997912
Name:KENNEMER, ROBERT DALE (DDS,MS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DALE
Last Name:KENNEMER
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 1:1012 E 29TH ST
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-1902
Mailing Address - Country:US
Mailing Address - Phone:785-625-9714
Mailing Address - Fax:785-625-7870
Practice Address - Street 1:1012 E 29TH ST
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-1902
Practice Address - Country:US
Practice Address - Phone:785-625-9714
Practice Address - Fax:785-625-7870
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS64791223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics