Provider Demographics
NPI:1295870764
Name:WILHALME, KENNETH R (DMD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:R
Last Name:WILHALME
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 COMANCHE DR
Mailing Address - Street 2:
Mailing Address - City:OCEANPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:07757-1553
Mailing Address - Country:US
Mailing Address - Phone:732-223-9199
Mailing Address - Fax:
Practice Address - Street 1:2517 HIGHWAY 35
Practice Address - Street 2:SUITE B 205
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-1918
Practice Address - Country:US
Practice Address - Phone:732-223-9199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01469300122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist