Provider Demographics
NPI:1922169259
Name:ALFORD, KENNETH DWAIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:DWAIN
Last Name:ALFORD
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:PO BOX 155
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:KY
Mailing Address - Zip Code:42320-0155
Mailing Address - Country:US
Mailing Address - Phone:270-274-4875
Mailing Address - Fax:270-274-2418
Practice Address - Street 1:1269 DUVALL RD
Practice Address - Street 2:SUITE 2
Practice Address - City:BEAVER DAM
Practice Address - State:KY
Practice Address - Zip Code:42320
Practice Address - Country:US
Practice Address - Phone:270-274-4875
Practice Address - Fax:270-274-2418
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY50711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60050713Medicaid