Provider Demographics
NPI:1871723395
Name:BERO, KENNETH MOSES JR (DDS)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:MOSES
Last Name:BERO
Suffix:JR
Gender:M
Credentials:DDS
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Mailing Address - Street 1:533 SOUTH MAIN ST
Mailing Address - Street 2:THE GENTLE DENTAL EMPORIUM LLC
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095
Mailing Address - Country:US
Mailing Address - Phone:262-338-8704
Mailing Address - Fax:262-338-9140
Practice Address - Street 1:533 SOUTH MAIN ST.
Practice Address - Street 2:THE GENTLE DENTAL EMPORIUM LLC
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095
Practice Address - Country:US
Practice Address - Phone:262-338-8704
Practice Address - Fax:262-338-9140
Is Sole Proprietor?:No
Enumeration Date:2009-07-17
Last Update Date:2009-07-17
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Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WIWI2517K122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist