Provider Demographics
NPI:1164502522
Name:KENNETH J SMITH DDS PSC
Entity Type:Organization
Organization Name:KENNETH J SMITH DDS PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:606-784-8983
Mailing Address - Street 1:504 SKAGGS RD
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-8852
Mailing Address - Country:US
Mailing Address - Phone:606-784-7679
Mailing Address - Fax:606-784-4408
Practice Address - Street 1:709 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1443
Practice Address - Country:US
Practice Address - Phone:606-784-8983
Practice Address - Fax:606-784-4408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered122300000XDental ProvidersDentistGroup - Multi-Specialty
Not Answered204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY61941233Medicaid
KY64043003Medicaid
KY60043007Medicaid
KY65911950Medicaid
KY61941233Medicaid
KY60043007Medicaid