| NPI | 1295881795 |
|---|---|
| Professional Name | T KEN ETHEREDGE |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 13079) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 13079) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2024-12-24 |