Provider Demographics
NPI:1184703647
Name:WORTZEL, KENNETH MARTIN (DDS)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:MARTIN
Last Name:WORTZEL
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 1:3838 E FORT LOWELL RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-1731
Mailing Address - Country:US
Mailing Address - Phone:520-881-4604
Mailing Address - Fax:520-320-0088
Practice Address - Street 1:3838 E FORT LOWELL RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-1731
Practice Address - Country:US
Practice Address - Phone:520-881-4604
Practice Address - Fax:520-320-0088
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1829122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist