Individual
DR. KENNETH CHARLES PRINCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
205 N BERKLEY AVE, COUNCIL, ID 83612
(208) 253-4242
Mailing address
PO BOX 428, COUNCIL, ID 83612-0428
(208) 253-4242
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D4335
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
527932
UNITED CONCORDIA
—
01
—
PR1900
REGENCE BLUE SHIELD
—
Enumeration date
06/07/2006
Last updated
09/13/2012
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