Provider Demographics
NPI:1114920840
Name:DORING, KEVIN RICHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:RICHARD
Last Name:DORING
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 1:3179 BRAVERTON ST
Mailing Address - Street 2:STE 100
Mailing Address - City:EDGEWATER
Mailing Address - State:MD
Mailing Address - Zip Code:21037-2666
Mailing Address - Country:US
Mailing Address - Phone:410-956-2505
Mailing Address - Fax:410-956-4060
Practice Address - Street 1:3179 BRAVERTON ST
Practice Address - Street 2:STE 100
Practice Address - City:EDGEWATER
Practice Address - State:MD
Practice Address - Zip Code:21037-2666
Practice Address - Country:US
Practice Address - Phone:410-956-2505
Practice Address - Fax:410-956-4060
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD085481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD08548OtherDENTAL LICENSE