Provider Demographics
NPI:1457539025
Name:OSWALD, KENNY ROY (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNY
Middle Name:ROY
Last Name:OSWALD
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 1:3557 MONTERREY DRIVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70814
Mailing Address - Country:US
Mailing Address - Phone:225-927-8968
Mailing Address - Fax:225-925-2258
Practice Address - Street 1:3557 MONTERREY DRIVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70814
Practice Address - Country:US
Practice Address - Phone:225-927-8968
Practice Address - Fax:225-925-2258
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2223122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist