Provider Demographics
NPI:1245248152
Name:WEBSTER, KENNETH HAROLD (DDS)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:HAROLD
Last Name:WEBSTER
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 1:280 SIERRA COLLEGE DRIVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945
Mailing Address - Country:US
Mailing Address - Phone:530-477-5060
Mailing Address - Fax:530-477-1066
Practice Address - Street 1:280 SIERRA COLLEGE DRIVE
Practice Address - Street 2:SUITE 240
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945
Practice Address - Country:US
Practice Address - Phone:530-477-5060
Practice Address - Fax:530-477-1066
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18218122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist