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1033196118
KENNETH WAYNE VANSICKLE
SANTA FE, NM
NPI
1033196118
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
1223G0001X Dentist, General Practice
(Licence: NM DD2304)
Enumeration Date
2005-12-29
Last Update Date
2013-04-23
Business Address
Dr. KENNETH WAYNE VANSICKLE D.M.D
2008 SAINT MICHAELS DR SUITE B
SANTA FE, NM 87505-7682
Phone number: 505-474-4993
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Mailing Address
Dr. KENNETH WAYNE VANSICKLE D.M.D
16 ARCADE UNIT 198747
NASHVILLE, TN 37219-1994
Phone number: 615-750-0343
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