# KENNETH W CHILDRESS DDS PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1982913935
- **Authorized official:** KENNETH CHILDRESS DDS (PRESIDENT)
- **Authorized official phone:** (719) 671-7369

## Contact information

- **Practice address:** 721 MECHEM DR, SIERRA MALL \#5, RUIDOSO, NM 88345-6911
- **Practice address phone:** (575) 257-0246
- **Mailing address:** 721 MECHEM DR, SIERRA MALL \#5, RUIDOSO, NM 88345-6911

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 2704 | NM | Yes |

## Other

- **Enumeration date:** 09/24/2010
- **Last updated:** 03/14/2012