Healthcare Provider Details

I. General information

NPI: 1891997912
Provider Name (Legal Business Name): ROBERT DALE KENNEMER DDS,MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 E 29TH ST
HAYS KS
67601-1902
US

IV. Provider business mailing address

1012 E 29TH ST
HAYS KS
67601-1902
US

V. Phone/Fax

Practice location:
  • Phone: 785-625-9714
  • Fax: 785-625-7870
Mailing address:
  • Phone: 785-625-9714
  • Fax: 785-625-7870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number6479
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: