Provider Demographics
NPI:1447374335
Name:GROVE, KENNETH EUGENE JR (DDS)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:EUGENE
Last Name:GROVE
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 1:2146 E MIER RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-8338
Mailing Address - Country:US
Mailing Address - Phone:989-835-7319
Mailing Address - Fax:
Practice Address - Street 1:2821 W WACKERLY ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-6995
Practice Address - Country:US
Practice Address - Phone:989-631-8790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010155391223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics