Anderson, Kenneth Mark

Anderson, Kenneth Mark is an individual health care provider with primary practice located at 875 Union Ave Room C309, Memphis TN 38163-0001. He recently has only one registered license in Dental Providers / Oral and Maxillofacial Pathology, which is considered as his primary health care specialty. Anderson, Kenneth Mark can be contacted via phone (901) 448-5876.

Contact Information

Primary practice address
875 Union Ave Room C309 Memphis TN 38163-0001
Fax: (901) 448-6835
Website:

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Oral and Maxillofacial Pathology 1223P0106X DDS8053 Tennessee

Profile Details

NPI number 1245316017
LBN Legal business name Anderson, Kenneth Mark
Credentials DDS,MS
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 27th, 2006
Last updated Sep 5th, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1245316017 NPPES
Tennessee Other 4075323 BCBS

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