Provider Demographics
NPI:1902007305
Name:RAWLINSON, KENNETH J (DDS)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:J
Last Name:RAWLINSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2861 PAWTUCKET AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-4939
Mailing Address - Country:US
Mailing Address - Phone:401-434-1334
Mailing Address - Fax:
Practice Address - Street 1:2861 PAWTUCKET AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915-4939
Practice Address - Country:US
Practice Address - Phone:401-434-1334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI025591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice