MEDICARE: DR. KENNETH DEAN GUESS D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	8153	NC

General Provider Information

NPI Number	:	1295981603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH DEAN GUESS D.D.S.

Provider Business Mailing Address
First Line	:	2503 SOCO RD.
Second Line	:
City	:	MAGGIE VALLEY
State	:	NC
Zip	:	28751
Country	:	US
Telephone Number	:	828-926-0054
Fax Number	:	828-926-3080

Provider Business Practice Location Address
First Line	:	2503 SOCO RD.
Second Line	:
City	:	MAGGIE VALLEY
State	:	NC
Zip	:	28751
Country	:	US
Telephone Number	:	828-926-0054
Fax Number	:	828-926-3080

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2008
Last Update Date	:	08/18/2008

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