Provider Demographics
NPI:1487296620
Name:ALBRIGHT, KELVIN BERNARD JR (N/A)
Entity type:Individual
Prefix:MR
First Name:KELVIN
Middle Name:BERNARD
Last Name:ALBRIGHT
Suffix:JR
Gender:M
Credentials:N/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6455 MACHINE STREET
Mailing Address - Street 2:
Mailing Address - City:APG
Mailing Address - State:MD
Mailing Address - Zip Code:21005
Mailing Address - Country:US
Mailing Address - Phone:912-484-2953
Mailing Address - Fax:
Practice Address - Street 1:6455 MACHINE STREET
Practice Address - Street 2:
Practice Address - City:APG
Practice Address - State:MD
Practice Address - Zip Code:21005
Practice Address - Country:US
Practice Address - Phone:410-278-1795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant