Provider Demographics
NPI:1457624173
Name:KENNETH KING BARTON, DDS
Entity Type:Organization
Organization Name:KENNETH KING BARTON, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:KING
Authorized Official - Last Name:BARTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:409-729-0300
Mailing Address - Street 1:2770 AERO DR STE 2
Mailing Address - Street 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 STE 2
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77640-1519
Practice Address - Country:US
Practice Address - Phone:409-729-0300
Practice Address - Fax:409-729-0300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104941223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1108631Medicaid
TX1108631Medicaid