Healthcare Provider Details

I. General information

NPI: 1467469692
Provider Name (Legal Business Name): KEVIN CHARLES SMITH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 12/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 ORLEANS RD STE A
NORTH CHATHAM MA
02650-1184
US

IV. Provider business mailing address

212 ORLEANS RD STE A
NORTH CHATHAM MA
02650-1184
US

V. Phone/Fax

Practice location:
  • Phone: 508-945-4870
  • Fax: 508-945-6062
Mailing address:
  • Phone: 508-945-4870
  • Fax: 508-945-6062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number19628
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: