Healthcare Provider Details

I. General information

NPI: 1043435076
Provider Name (Legal Business Name): KENNETH BRIAN FROSTAD D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 03/07/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8680 GREENBACK LANE SUITE 109
ORANGEVALE CA
95662
US

IV. Provider business mailing address

8680 GREENBACK LANE SUITE 109
ORANGEVALE CA
95662
US

V. Phone/Fax

Practice location:
  • Phone: 916-962-0545
  • Fax: 916-962-0927
Mailing address:
  • Phone: 916-962-0545
  • Fax: 916-962-0927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number22882
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: