Provider Demographics
NPI:1356225973
Name:KENNY A ROBLES GONZALEZ DDS PC
Entity type:Organization
Organization Name:KENNY A ROBLES GONZALEZ DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROBLES GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-788-4444
Mailing Address - Street 1:3253 S HARLEM AVE UNIT 1C
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-2996
Mailing Address - Country:US
Mailing Address - Phone:708-788-4444
Mailing Address - Fax:708-788-4474
Practice Address - Street 1:3253 S HARLEM AVE UNIT 1C
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-2996
Practice Address - Country:US
Practice Address - Phone:708-788-4444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental