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General NPI Number Information
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NPI Number | 1124009816
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Entity Type | Individual
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Provider Name | KENNETH MARK BUILDER DMD
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Gender | Male
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Dates
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Enumeration Date | 11/09/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 123 SE DOUGLAS ST
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City | NEWPORT
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State | OR
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Zip | 97365-4426
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Country | US
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Telephone | 541-265-4221
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Fax | 541-574-6552
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Provider Business Mailing Address
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Address Line | PO BOX 1045
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City | NEWPORT
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State | OR
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Zip | 97365-0080
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Country | US
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Telephone | 541-265-4221
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Fax | 541-574-6552
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D7773
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License Number State | OR
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