Healthcare Provider Details

I. General information

NPI: 1487759361
Provider Name (Legal Business Name): THE KID'S DENTIST, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 03/04/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7230 LEE DEFOREST DR STE 107N
COLUMBIA MD
21046-3202
US

IV. Provider business mailing address

7230 LEE DEFOREST DR STE 107N
COLUMBIA MD
21046-3202
US

V. Phone/Fax

Practice location:
  • Phone: 443-622-8908
  • Fax: 443-819-1659
Mailing address:
  • Phone: 443-622-8908
  • Fax: 443-819-1659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. NNEKA DAVIS
Title or Position: OWNER/PEDIATRIC DENTIST
Credential: DMD
Phone: 443-622-8908