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General NPI Number Information
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NPI Number | 1801927058
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Entity Type | Individual
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Provider Name | KENNETH EDWARD ENDRES D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 33 HARTFORD AVENUE BOX 330
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City | GRANBY
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State | CT
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Zip | 06035
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Country | US
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Telephone | 860-653-4551
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Fax | 860-653-4552
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Provider Business Mailing Address
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Address Line | 10 HELENA RD
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City | AVON
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State | CT
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Zip | 06001-3432
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Country | US
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Telephone | 860-673-7738
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Fax | 860-673-0836
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 06442
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License Number State | CT
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