MEDICARE: KENNETH C. ACKLEY, 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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1528736113
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENNETH C. ACKLEY, D.D.S.

Provider Business Mailing Address
First Line	:	6452 MILLENNIUM STE 110
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48917-7881
Country	:	US
Telephone Number	:	517-323-0922
Fax Number	:	517-323-9006

Provider Business Practice Location Address
First Line	:	6452 MILLENNIUM STE 110
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48917-7881
Country	:	US
Telephone Number	:	517-323-0922
Fax Number	:	517-323-9006

Authorized Official
Title or Position	:	FINANCIAL COORDINATOR
Name	:	MRS. KATHLEEN M. MOORE
Credential	:
Telephone Number	:	810-334-0683

Provider Enumeration Date	:	08/31/2021
Last Update Date	:	08/31/2021

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