Healthcare Provider Details

I. General information

NPI: 1104819549
Provider Name (Legal Business Name): KENNETH ARTHUR KEHEW DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 08/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 VALLEY RD
MIDDLETOWN RI
02842-5237
US

IV. Provider business mailing address

74 VALLEY RD
MIDDLETOWN RI
02842-5237
US

V. Phone/Fax

Practice location:
  • Phone: 401-847-4570
  • Fax:
Mailing address:
  • Phone: 401-847-4570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2110
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: