Individual
DR. KENNETH S DETTLAFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1725 E WARM SPRINGS RD STE 2, LAS VEGAS, NV 89119-0421
(702) 270-8790
(702) 270-8928
Mailing address
PO BOX 17179, IRVINE, CA 92623-7179
(949) 567-3176
(949) 567-3185
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4314T
NV
Other
Enumeration date
10/27/2006
Last updated
07/08/2007
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