Kenneth Eugene Koenke, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

3792 Issued in ME

Practice address

37 Bow St
Freeport, ME 04032

Phone

(207) 865-0673

NPI assigned

Dec 8, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Dr. Kenneth Eugene Koenke Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1801955364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13063 BROOKMEAD DR",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "20112",
            "telephone_number": "703-794-9219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "37 BOW ST",
            "city": "FREEPORT",
            "state": "ME",
            "postal_code": "04032",
            "telephone_number": "207-865-0673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOENKE",
        "first_name": "KENNETH",
        "middle_name": "EUGENE",
        "name_prefix": "Mr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ME",
            "license": "3792",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "12625",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KENNETH",
            "last_name": "KOENKE",
            "middle_name": "EUGENE",
            "prefix": "DR.",
            "credential": "DDS",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Susan Walsh Kelley, OTR/L
• Kevin R Kenerson, DO
• Kevin Zorski D.O. LLC
• Margaret Revelle Kimball
• Brian Keith Knighton, D.O.
• Brenda Krueger, RDH
• Maureen Elizabeth Lagrua, LPC
• Karen Marie Lambert, M.S./CCC/SPEECH PATH
• David C Lilly, PSYD
• Lisa W Lucas, D.O.

• General Practice Dentistry in Freeport, ME
• Providers in Freeport, ME by specialty
• General Practice Dentistry in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.