Provider Demographics
NPI:1841645231
Name:CLOW, KENNETH MCKENZIE (DMD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:MCKENZIE
Last Name:CLOW
Suffix:
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:PO BOX 876
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-0059
Mailing Address - Country:US
Mailing Address - Phone:503-880-3733
Mailing Address - Fax:
Practice Address - Street 1:442 SW UMATILLA AVE STE 200
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-7039
Practice Address - Country:US
Practice Address - Phone:888-480-4478
Practice Address - Fax:541-504-3907
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK135501122300000X
390200000X
ORD10652122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program