Healthcare Provider Details

I. General information

NPI: 1871683391
Provider Name (Legal Business Name): KENNETH LLOYD GUDZ D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 OFFICE PARK RD SUITE 207
HILTON HEAD SC
29928-4637
US

IV. Provider business mailing address

32 OFFICE PARK RD SUITE 207
HILTON HEAD SC
29928-4637
US

V. Phone/Fax

Practice location:
  • Phone: 843-785-4801
  • Fax: 843-785-7804
Mailing address:
  • Phone: 843-785-4801
  • Fax: 843-785-7804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberSC3319
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: