MEDICARE: THE KID'S DENTIST, P.A.

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
1	1223P0221X	Pediatric Dentistry

Other Identifiers

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

General Provider Information

NPI Number	:	1487759361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE KID'S DENTIST, P.A.

Provider Business Mailing Address
First Line	:	7230 LEE DEFOREST DR
Second Line	:	STE 107N
City	:	COLUMBIA
State	:	MD
Zip	:	21046-3202
Country	:	US
Telephone Number	:	443-622-8908
Fax Number	:	443-819-1659

Provider Business Practice Location Address
First Line	:	7230 LEE DEFOREST DR
Second Line	:	STE 107N
City	:	COLUMBIA
State	:	MD
Zip	:	21046-3202
Country	:	US
Telephone Number	:	443-622-8908
Fax Number	:	443-819-1659

Authorized Official
Title or Position	:	OWNER/PEDIATRIC DENTIST
Name	:	DR. NNEKA DAVIS
Credential	:	DMD
Telephone Number	:	443-622-8908

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	03/04/2024

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