Provider Demographics
NPI:1447469929
Name:JOHN KELMENSON,DDS,LLC
Entity type:Organization
Organization Name:JOHN KELMENSON,DDS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KELMENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-933-1099
Mailing Address - Street 1:7939 HONEYGO BLVD
Mailing Address - Street 2:SUITE 214
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4931
Mailing Address - Country:US
Mailing Address - Phone:410-933-1099
Mailing Address - Fax:410-933-6616
Practice Address - Street 1:7939 HONEYGO BLVD
Practice Address - Street 2:SUITE 214
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-4931
Practice Address - Country:US
Practice Address - Phone:410-933-1099
Practice Address - Fax:410-933-6616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD76431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD=========OtherTIN