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NPI Code Detail

MEDICARE: KENNETH J SMITH DDS

MEDICARE: KENNETH J SMITH DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist
2204E00000XOral & Maxillofacial Surgery (D.M.D.)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1457411415
Entity Type Code : Organization
Provider Name (Legal Business Name) : KENNETH J SMITH DDS
Provider Business Mailing Address
First Line : 399 W MAPLE LEAF RD
Second Line :
City : MAYSVILLE
State : KY
Zip : 41056-9176
Country : US
Telephone Number : 606-564-9495
Fax Number : 606-564-9495
Provider Business Practice Location Address
First Line : 399 W MAPLE LEAF RD
Second Line :
City : MAYSVILLE
State : KY
Zip : 41056-9176
Country : US
Telephone Number : 606-564-9495
Fax Number : 606-564-9495
Authorized Official
Title or Position : PRESIDENT
Name : MR. KENNETH J SMITH
Credential : DDS
Telephone Number : 606-784-8983
Provider Enumeration Date : 12/11/2006
Last Update Date : 09/11/2025

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