Individual
DR. KENNETH CLARK PRIDDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
853 MEDICAL DR STE 115, WENTZVILLE, MO 63385-3825
(636) 887-3100
(636) 887-3102
Mailing address
1 MID RIVERS MALL DR STE 310, SAINT PETERS, MO 63376-4323
(636) 928-7217
(636) 397-0223
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
2021048521
MO
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
9781
KY
Other
Enumeration date
03/28/2016
Last updated
06/28/2022
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