Provider Demographics
NPI:1447330378
Name:WHELAN, KENNETH G JR (DDS)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:G
Last Name:WHELAN
Suffix:JR
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 1:18700 MAIN ST.
Mailing Address - Street 2:UNIT 204
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648
Mailing Address - Country:US
Mailing Address - Phone:714-465-5094
Mailing Address - Fax:
Practice Address - Street 1:18700 MAIN ST
Practice Address - Street 2:UNIT 204
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1706
Practice Address - Country:US
Practice Address - Phone:714-465-5094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2015-10-15
Deactivation Date:2014-01-07
Deactivation Code:
Reactivation Date:2015-09-04
Provider Licenses
StateLicense IDTaxonomies
CA47583122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist