=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689862435
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KENNETH S SINGLETON DDS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2007
-----------------------------------------------------
Last Update Date | 10/05/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 624 HARRIS ST
-----------------------------------------------------
City | EUREKA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95503-4448
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-442-5739
-----------------------------------------------------
Fax | 707-442-9013
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 624 HARRIS ST
-----------------------------------------------------
City | EUREKA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95503-4448
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-442-5739
-----------------------------------------------------
Fax | 707-442-9013
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | KENNETH S SINGLETON
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 707-442-5739
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 25216
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------