Healthcare Provider Details

I. General information

NPI: 1366530719
Provider Name (Legal Business Name): KENNETH EARL FOLLMAR II DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 11/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14511 SOUTH BASCOM AVE
LOS GATOS CA
95032
US

IV. Provider business mailing address

14511 SOUTH BASCOM AVE
LOS GATOS CA
95032
US

V. Phone/Fax

Practice location:
  • Phone: 408-356-3146
  • Fax: 408-356-0267
Mailing address:
  • Phone: 408-356-3146
  • Fax: 408-356-0267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number30785
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: