Healthcare Provider Details

I. General information

NPI: 1841645231
Provider Name (Legal Business Name): KENNETH MCKENZIE CLOW D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8995 SW MILEY RD STE 101
WILSONVILLE OR
97070-5485
US

IV. Provider business mailing address

28651 GREENWAY DR
WILSONVILLE OR
97070-7752
US

V. Phone/Fax

Practice location:
  • Phone: 971-433-2724
  • Fax:
Mailing address:
  • Phone: 503-880-3733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number135501
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD10652
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number25369
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: