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General NPI Number Information
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NPI Number | 1528736113
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Entity Type | Organization
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Legal Business Name | KENNETH C. ACKLEY, D.D.S.
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Dates
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Enumeration Date | 08/31/2021
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Last Update Date | 08/31/2021
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Provider Practice Location Address
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Address Line | 6452 MILLENNIUM STE 110
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City | LANSING
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State | MI
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Zip | 48917-7881
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Country | US
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Telephone | 517-323-0922
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Fax | 517-323-9006
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Provider Business Mailing Address
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Address Line | 6452 MILLENNIUM STE 110
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City | LANSING
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State | MI
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Zip | 48917-7881
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Country | US
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Telephone | 517-323-0922
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Fax | 517-323-9006
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Authorized Official
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Title or Position | FINANCIAL COORDINATOR
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Name | MRS. KATHLEEN M. MOORE
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Credential |
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Telephone | 810-334-0683
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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