Provider Demographics
NPI:1336268507
Name:CARSTO, KENNETH C
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:C
Last Name:CARSTO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:854 MOUNTAIN TOP DR
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-4139
Mailing Address - Country:US
Mailing Address - Phone:610-489-0176
Mailing Address - Fax:
Practice Address - Street 1:2 COWPATH RD
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-1227
Practice Address - Country:US
Practice Address - Phone:215-368-2424
Practice Address - Fax:215-361-7292
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0239721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice