Healthcare Provider Details

I. General information

NPI: 1043320161
Provider Name (Legal Business Name): KENNETH C KATES JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10345 SOUTHERN MARYLAND BLVD SUITE 211
DUNKIRK MD
20754
US

IV. Provider business mailing address

PO BOX 1233
DUNKIRK MD
20754-1233
US

V. Phone/Fax

Practice location:
  • Phone: 410-257-2424
  • Fax: 301-855-8373
Mailing address:
  • Phone: 410-257-2424
  • Fax: 301-855-8373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5475
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: