Provider Demographics
NPI:1013110691
Name:ARCHIBALD, KENT DARRELL (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:DARRELL
Last Name:ARCHIBALD
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 1:910 LITTLEPAGE ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4700
Mailing Address - Country:US
Mailing Address - Phone:540-373-5642
Mailing Address - Fax:540-373-5706
Practice Address - Street 1:910 LITTLEPAGE ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4700
Practice Address - Country:US
Practice Address - Phone:540-373-5642
Practice Address - Fax:540-373-5706
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014118011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice