Provider Demographics
NPI:1942225024
Name:KENNINGTON, LESTER BLAINE (DDS)
Entity Type:Individual
Prefix:
First Name:LESTER
Middle Name:BLAINE
Last Name:KENNINGTON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:L.
Other - Middle Name:BLAINE
Other - Last Name:KENNINGTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 458
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:WA
Mailing Address - Zip Code:98611-0458
Mailing Address - Country:US
Mailing Address - Phone:360-274-9100
Mailing Address - Fax:360-274-8152
Practice Address - Street 1:358 FRONT AVE NW
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:WA
Practice Address - Zip Code:98611-0458
Practice Address - Country:US
Practice Address - Phone:360-274-9100
Practice Address - Fax:360-274-8152
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADEAOOOO92741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice