Provider Demographics
NPI:1376551556
Name:BARTON, KENNETH KING (DDS)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:KING
Last Name:BARTON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2770 AERO DRIVE
Mailing Address - Street 2:STE 2
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77640-1519
Mailing Address - Country:US
Mailing Address - Phone:409-729-0300
Mailing Address - Fax:409-729-0319
Practice Address - Street 1:2770 AERO DR
Practice Address - Street 2:STE 2
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77640-1518
Practice Address - Country:US
Practice Address - Phone:409-729-0300
Practice Address - Fax:409-729-0319
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104941223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1108631Medicaid
TX1108631Medicaid