MEDICARE: DR. KENNETH C ACKLEY II DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2901019074	MI

General Provider Information

NPI Number	:	1891795639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH C ACKLEY II DDS

Provider Business Mailing Address
First Line	:	573 W VIENNA ST
Second Line	:
City	:	CLIO
State	:	MI
Zip	:	48420-5000
Country	:	US
Telephone Number	:	810-686-5220
Fax Number	:

Provider Business Practice Location Address
First Line	:	573 W VIENNA ST
Second Line	:
City	:	CLIO
State	:	MI
Zip	:	48420-5000
Country	:	US
Telephone Number	:	810-686-5220
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	02/26/2026

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