Healthcare Provider Details

I. General information

NPI: 1720175946
Provider Name (Legal Business Name): KEVIN Y. MYINT, DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 07/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 BIG ELK MALL
ELKTON MD
21921-5912
US

IV. Provider business mailing address

2939 AIRDRIE AVE
ABINGDON MD
21009-2422
US

V. Phone/Fax

Practice location:
  • Phone: 410-398-9500
  • Fax: 410-398-0427
Mailing address:
  • Phone: 410-569-0918
  • Fax: 410-398-0427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12530
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number12461
License Number StateMD

VIII. Authorized Official

Name: DR. KEVIN Y MYINT
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 410-398-9500