Provider Demographics
NPI:1457551897
Name:HANCOCK, KENNETH LINC (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:LINC
Last Name:HANCOCK
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 1:3240 14TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-8509
Mailing Address - Country:US
Mailing Address - Phone:360-866-7669
Mailing Address - Fax:360-866-9115
Practice Address - Street 1:3240 14TH AVE NW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8509
Practice Address - Country:US
Practice Address - Phone:360-866-7669
Practice Address - Fax:360-866-9115
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000092431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice