Healthcare Provider Details

I. General information

NPI: 1487611406
Provider Name (Legal Business Name): KENNETH J SMITH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 W MAIN ST
MOREHEAD KY
40351-1443
US

IV. Provider business mailing address

504 SKAGGS RD
MOREHEAD KY
40351-8852
US

V. Phone/Fax

Practice location:
  • Phone: 606-784-8983
  • Fax: 606-784-4408
Mailing address:
  • Phone: 606-784-7679
  • Fax: 606-784-4408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number4300
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number4300
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: