Healthcare Provider Details

I. General information

NPI: 1629933437
Provider Name (Legal Business Name): SERGE KENS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2025
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 S PATTERSON PARK AVE
BALTIMORE MD
21231-2123
US

IV. Provider business mailing address

226 S PATTERSON PARK AVE
BALTIMORE MD
21231-2123
US

V. Phone/Fax

Practice location:
  • Phone: 917-916-3242
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDENT.DE.70082
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: