NPI 1033196118

Kenneth Wayne Vansickle, DMD

Practitioner General Practice Dentistry Santa Fe, NM

Practice location

Address: 2008 Saint Michaels Dr Suite B, Santa Fe, NM 87505-7682
Phone: (505) 474-4993
Fax: (505) 474-4973
Mailing address: 16 Arcade Unit 198747, Nashville, TN 37219-1994

Registered specialties

General Practice Dentistry Primary

Dental Providers Taxonomy 1223G0001X Licence DD2304 (NM)

Other Dentist providers in New Mexico →

Registry record

NPI: 1033196118
Entity type: Individual
Sex (as registered): Male
NPI issued: 29 Dec 2005
Record last updated: 23 Apr 2013

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.