MEDICARE: DR. KEVIN RICHARD DORING DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	08548	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	08548	OTHER	MD	DENTAL LICENSE

General Provider Information

NPI Number	:	1114920840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN RICHARD DORING DDS

Provider Business Mailing Address
First Line	:	3179 BRAVERTON ST
Second Line	:	STE 100
City	:	EDGEWATER
State	:	MD
Zip	:	21037-2666
Country	:	US
Telephone Number	:	410-956-2505
Fax Number	:	410-956-4060

Provider Business Practice Location Address
First Line	:	3179 BRAVERTON ST
Second Line	:	STE 100
City	:	EDGEWATER
State	:	MD
Zip	:	21037-2666
Country	:	US
Telephone Number	:	410-956-2505
Fax Number	:	410-956-4060

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	07/08/2007

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