Provider Demographics
NPI:1780885160
Name:EYE, KENNETH ROBERT II (DDS)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ROBERT
Last Name:EYE
Suffix:II
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2955 CRAIN HWY
Mailing Address - Street 2:SUITE O
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-2810
Mailing Address - Country:US
Mailing Address - Phone:301-645-1344
Mailing Address - Fax:301-645-4654
Practice Address - Street 1:20955 PROFESSIONAL PLZ
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-3405
Practice Address - Country:US
Practice Address - Phone:703-723-0014
Practice Address - Fax:703-723-0949
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0401411947122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program