Provider Demographics
NPI:1023296241
Name:MOORE, KENNETH E II (DDS)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:E
Last Name:MOORE
Suffix:II
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 1:625 MENLO AVE
Mailing Address - Street 2:#5
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4747
Mailing Address - Country:US
Mailing Address - Phone:650-328-8544
Mailing Address - Fax:650-382-9405
Practice Address - Street 1:625 MENLO AVE
Practice Address - Street 2:#5
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4747
Practice Address - Country:US
Practice Address - Phone:650-328-8544
Practice Address - Fax:650-382-9405
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-11
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56014122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist