Individual
MR. KENNETH EUGENE KOENKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
37 BOW ST, FREEPORT, ME 04032
(207) 865-0673
Mailing address
13063 BROOKMEAD DR, MANASSAS, VA 20112
(703) 794-9219
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
12625
MO
1223G0001X
General Practice Dentistry
Primary
3792
ME
Other
Enumeration date
12/08/2006
Last updated
07/08/2007
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