Healthcare Provider Details

I. General information

NPI: 1730296708
Provider Name (Legal Business Name): KENNETH H LEDGAND DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 11/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 DANFORTH ST
REHOBOTH MA
02769
US

IV. Provider business mailing address

20 DANFORTH ST
REHOBOTH MA
02769
US

V. Phone/Fax

Practice location:
  • Phone: 508-252-6327
  • Fax: 774-565-0027
Mailing address:
  • Phone: 508-252-6327
  • Fax: 774-565-0027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberMA13895
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: