Provider Demographics
NPI:1134359656
Name:PILCHER, KENNETH J (DDS)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:J
Last Name:PILCHER
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 1:508 CORDA BLVD
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-4935
Mailing Address - Country:US
Mailing Address - Phone:765-362-1189
Mailing Address - Fax:765-362-1190
Practice Address - Street 1:508 CORDA BLVD
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-4935
Practice Address - Country:US
Practice Address - Phone:765-362-1189
Practice Address - Fax:765-362-1190
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-17
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009141122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200309510AMedicaid