Dr. Kenneth Liard Gould III, D.D.S.
Dentist, General Practice in Racine, WI. Individual provider (NPI-1).
NPI number1144243643
StatusActive
Last updated in NPPESJul 8, 2007
Details
- NPI
- 1144243643
- Entity type
- Individual (NPI-1)
- Name
- Dr. Kenneth Liard Gould III
- Credential
- D.D.S.
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Jul 25, 2006
- Last updated
- Jul 8, 2007
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | 5805-015 | WI | Yes |
Practice location
1831 S Greenbay RdRacine, WI 53406-4605
Phone 262-633-0080 · Fax 262-619-0311
Mailing address
1831 S Greenbay RdRacine, WI 53406-4605
Phone 262-633-0080 · Fax 262-619-0311
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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