Provider Demographics
NPI:1447275672
Name:CHILDERS, KENNETH LLOYD (DDS)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:LLOYD
Last Name:CHILDERS
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 1:6116 MERCED AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-2917
Mailing Address - Country:US
Mailing Address - Phone:510-339-2792
Mailing Address - Fax:510-339-3159
Practice Address - Street 1:6116 MERCED AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-2917
Practice Address - Country:US
Practice Address - Phone:510-339-2792
Practice Address - Fax:510-339-3159
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA223291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice