Healthcare Provider Details

I. General information

NPI: 1649390071
Provider Name (Legal Business Name): KENNETH BINKLEY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 W. CHESTNUT STREET
PARDEEVILLE WI
53954
US

IV. Provider business mailing address

403 W. CHESTNUT ST. PO BOX 127
PARDEEVILLE WI
53954-0127
US

V. Phone/Fax

Practice location:
  • Phone: 608-429-3175
  • Fax: 608-429-3776
Mailing address:
  • Phone: 608-429-3175
  • Fax: 608-429-3776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5447015
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: