Healthcare Provider Details

I. General information

NPI: 1457411415
Provider Name (Legal Business Name): KENNETH J SMITH DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 W MAPLE LEAF RD
MAYSVILLE KY
41056-9176
US

IV. Provider business mailing address

399 W MAPLE LEAF RD
MAYSVILLE KY
41056-9176
US

V. Phone/Fax

Practice location:
  • Phone: 606-564-9495
  • Fax: 606-564-9495
Mailing address:
  • Phone: 606-564-9495
  • Fax: 606-564-9495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: MR. KENNETH J SMITH
Title or Position: PRESIDENT
Credential: DDS
Phone: 606-784-8983