MEDICARE: KEVIN Y. MYINT, 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	1223P0300X	Periodontics	12461	MD
2	122300000X	Dentist	12530	MD

General Provider Information

NPI Number	:	1720175946
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEVIN Y. MYINT, DDS

Provider Business Mailing Address
First Line	:	2939 AIRDRIE AVE
Second Line	:
City	:	ABINGDON
State	:	MD
Zip	:	21009-2422
Country	:	US
Telephone Number	:	410-569-0918
Fax Number	:	410-398-0427

Provider Business Practice Location Address
First Line	:	121 BIG ELK MALL
Second Line	:
City	:	ELKTON
State	:	MD
Zip	:	21921-5912
Country	:	US
Telephone Number	:	410-398-9500
Fax Number	:	410-398-0427

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KEVIN Y MYINT
Credential	:	D.D.S.
Telephone Number	:	410-398-9500

Provider Enumeration Date	:	10/09/2006
Last Update Date	:	07/31/2012

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