Provider Demographics
NPI:1528736113
Name:KENNETH C. ACKLEY, D.D.S.
Entity type:Organization
Organization Name:KENNETH C. ACKLEY, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-334-0683
Mailing Address - Street 1:6452 MILLENNIUM STE 110
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-7881
Mailing Address - Country:US
Mailing Address - Phone:517-323-0922
Mailing Address - Fax:517-323-9006
Practice Address - Street 1:6452 MILLENNIUM STE 110
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-7881
Practice Address - Country:US
Practice Address - Phone:517-323-0922
Practice Address - Fax:517-323-9006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental