Provider Demographics
NPI:1780800797
Name:WELBORNE, KENNETH MCNEIL (DDS)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:MCNEIL
Last Name:WELBORNE
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 1:9700 CALDWELL COMMONS CIRCLE
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031
Mailing Address - Country:US
Mailing Address - Phone:704-896-7955
Mailing Address - Fax:704-896-7992
Practice Address - Street 1:9700 CALDWELL COMMONS CIRCLE
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031
Practice Address - Country:US
Practice Address - Phone:704-896-7955
Practice Address - Fax:704-896-7992
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC61851223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice