Healthcare Provider Details

I. General information

NPI: 1740370840
Provider Name (Legal Business Name): KEMP MILL DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1299 LAMBERTON DR SUITE A
SILVER SPRING MD
20902-3411
US

IV. Provider business mailing address

1299 LAMBERTON DR SUITE A
SILVER SPRING MD
20902-3411
US

V. Phone/Fax

Practice location:
  • Phone: 301-649-1361
  • Fax: 301-649-3221
Mailing address:
  • Phone: 301-649-1361
  • Fax: 301-649-3221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number10996
License Number StateMD

VIII. Authorized Official

Name: SPENCER A GAKNER
Title or Position: PRESIDENT
Credential: DDS
Phone: 301-649-1361