Provider Demographics
NPI:1922747369
Name:STUMPF, KENNETH WILLIAM (DDS)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:WILLIAM
Last Name:STUMPF
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 1:1592 MARION MOUNT GILEAD RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-5820
Mailing Address - Country:US
Mailing Address - Phone:740-386-6600
Mailing Address - Fax:
Practice Address - Street 1:1598 MARION MOUNT GILEAD RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-5820
Practice Address - Country:US
Practice Address - Phone:740-386-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-02
Last Update Date:2022-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0268751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice