Individual
DR. CHARLES WESLEY KETCHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
228 LOMBARD ST STE C, THOUSAND OAKS, CA 91360-8202
(805) 496-3209
(805) 496-0351
Mailing address
228 LOMBARD ST STE C, THOUSAND OAKS, CA 91360-8202
(805) 496-3209
(805) 496-0351
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
23839
CA
Other
Enumeration date
02/19/2007
Last updated
07/08/2007
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