Individual
DR. KENNETH PATRICK MCINNIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
1791 NW 173RD AVE STE 130, BEAVERTON, OR 97006-5630
(503) 640-0395
Mailing address
1791 NW 173RD AVE STE 130, BEAVERTON, OR 97006-5630
(503) 640-0395
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6288
OR
Other
Enumeration date
07/22/2006
Last updated
10/24/2023
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