Provider Demographics
NPI:1780077198
Name:KENNETH C WARDEN DDS INC
Entity type:Organization
Organization Name:KENNETH C WARDEN DDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:WARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-899-9200
Mailing Address - Street 1:6742 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-1619
Mailing Address - Country:US
Mailing Address - Phone:614-899-9200
Mailing Address - Fax:
Practice Address - Street 1:6742 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-1619
Practice Address - Country:US
Practice Address - Phone:614-899-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0237691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH00743081Medicaid