Healthcare Provider Details

I. General information

NPI: 1093930679
Provider Name (Legal Business Name): EARL MALCOLM KUDLICK DDS MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2277 BEL PRE ROAD
SILVER SPRING MD
20906-2200
US

IV. Provider business mailing address

2277 BEL PRE ROAD
SILVER SPRING MD
20906-2200
US

V. Phone/Fax

Practice location:
  • Phone: 301-460-0770
  • Fax:
Mailing address:
  • Phone: 301-460-0770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN2478
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number4340
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: