Provider Demographics
NPI:1447501358
Name:WILLIAM D KENFIELD DDS LLC
Entity type:Organization
Organization Name:WILLIAM D KENFIELD DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:KENFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS LLC
Authorized Official - Phone:812-829-4886
Mailing Address - Street 1:77 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IN
Mailing Address - Zip Code:47460-1513
Mailing Address - Country:US
Mailing Address - Phone:812-829-4886
Mailing Address - Fax:812-829-4686
Practice Address - Street 1:77 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IN
Practice Address - Zip Code:47460-1513
Practice Address - Country:US
Practice Address - Phone:812-829-4886
Practice Address - Fax:812-829-4686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120078731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100195260AMedicaid