Vansickle, Kenneth Wayne

Vansickle, Kenneth Wayne is an individual health care provider with primary practice located at 2008 Saint Michaels Dr Suite B, Santa Fe NM 87505-7682. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Vansickle, Kenneth Wayne can be contacted via phone (505) 474-4993.

Contact Information

Primary practice address
2008 Saint Michaels Dr Suite B Santa Fe NM 87505-7682
Phone: (505) 474-4993
Fax: (505) 474-4973
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X DD2304 New Mexico

Profile Details

NPI number 1033196118
LBN Legal business name Vansickle, Kenneth Wayne
Credentials Doctor of Dental Medicine (DMD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 29th, 2005
Last updated Apr 23rd, 2013 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1033196118 NPPES
New Mexico Other 160531 UNITED CONCORDIA
New Mexico MEDICAID 9177992 UNITED CONCORDIA
New Mexico MEDICAID 52823083 UNITED CONCORDIA

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