Provider Demographics
NPI:1457693475
Name:FORDHAM, KENNETH CHARLES JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:CHARLES
Last Name:FORDHAM
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 BYERS RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER SPRINGS
Mailing Address - State:PA
Mailing Address - Zip Code:19425-9506
Mailing Address - Country:US
Mailing Address - Phone:610-458-3800
Mailing Address - Fax:610-458-3904
Practice Address - Street 1:241 BYERS RD
Practice Address - Street 2:
Practice Address - City:CHESTER SPRINGS
Practice Address - State:PA
Practice Address - Zip Code:19425-9506
Practice Address - Country:US
Practice Address - Phone:610-458-3800
Practice Address - Fax:610-458-3904
Is Sole Proprietor?:No
Enumeration Date:2013-03-18
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS023116L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist