Provider Demographics
NPI:1215381595
Name:KUFTA, KENNETH (DMD, MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:KUFTA
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 WEST ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3468
Mailing Address - Country:US
Mailing Address - Phone:410-268-7790
Mailing Address - Fax:
Practice Address - Street 1:275 WEST ST STE 100
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3468
Practice Address - Country:US
Practice Address - Phone:410-268-7790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-22
Last Update Date:2023-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD177491223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery