Provider Demographics
NPI:1801927058
Name:ENDRES, KENNETH EDWARD (DDS)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:EDWARD
Last Name:ENDRES
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 1:10 HELENA RD
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3432
Mailing Address - Country:US
Mailing Address - Phone:860-673-7738
Mailing Address - Fax:860-673-0836
Practice Address - Street 1:33 HARTFORD AVENUE
Practice Address - Street 2:BOX 330
Practice Address - City:GRANBY
Practice Address - State:CT
Practice Address - Zip Code:06035
Practice Address - Country:US
Practice Address - Phone:860-653-4551
Practice Address - Fax:860-653-4552
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT064421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice