Provider Demographics
NPI:1295731859
Name:LAPOLLA, KENNETH DOMINIC (DDS)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:DOMINIC
Last Name:LAPOLLA
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 1:8588 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-2339
Mailing Address - Country:US
Mailing Address - Phone:330-609-6565
Mailing Address - Fax:
Practice Address - Street 1:8588 E MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-2339
Practice Address - Country:US
Practice Address - Phone:330-609-6565
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30194321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0995697Medicaid