Provider Demographics
NPI:1043320161
Name:KATES, KENNETH C JR (DDS)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:C
Last Name:KATES
Suffix:JR
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:PO BOX 1233
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:MD
Mailing Address - Zip Code:20754-1233
Mailing Address - Country:US
Mailing Address - Phone:410-257-2424
Mailing Address - Fax:301-855-8373
Practice Address - Street 1:10345 SOUTHERN MARYLAND BLVD
Practice Address - Street 2:SUITE 211
Practice Address - City:DUNKIRK
Practice Address - State:MD
Practice Address - Zip Code:20754
Practice Address - Country:US
Practice Address - Phone:410-257-2424
Practice Address - Fax:301-855-8373
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD5475122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist