Provider Demographics
NPI:1902898430
Name:SMITH, KELVIN BRUCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KELVIN
Middle Name:BRUCE
Last Name:SMITH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7008 SECURITY BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2566
Mailing Address - Country:US
Mailing Address - Phone:410-277-9206
Mailing Address - Fax:410-277-9209
Practice Address - Street 1:7008 SECURITY BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21244-2566
Practice Address - Country:US
Practice Address - Phone:410-277-9206
Practice Address - Fax:410-277-9209
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD86501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice