Provider Demographics
NPI:1871598516
Name:HOLDER, KENNETH LEROY (DDS)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:LEROY
Last Name:HOLDER
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 1:420 E CALAVERAS BLVD
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-5412
Mailing Address - Country:US
Mailing Address - Phone:408-262-6800
Mailing Address - Fax:408-262-6007
Practice Address - Street 1:420 E CALAVERAS BLVD
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-5412
Practice Address - Country:US
Practice Address - Phone:408-262-6800
Practice Address - Fax:408-262-6007
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice