Individual
DR. KENNETH PAUL DOALTOWSKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, MS
Contact information
Practice address
2105 W GENESEE ST, SUITE 207, SYRACUSE, NY 13219-1656
(315) 468-0031
(315) 487-3599
Mailing address
509 EMANN DR, CAMILLUS, NY 13031-3011
(315) 487-1270
(315) 487-3599
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
032859-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00447374
—
NY
Enumeration date
06/04/2007
Last updated
07/09/2007
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