Provider Demographics
NPI:1295818219
Name:RHODES, JEFFERY KYLE (DDS)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:KYLE
Last Name:RHODES
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 1:952 SETON DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-1950
Mailing Address - Country:US
Mailing Address - Phone:301-759-4900
Mailing Address - Fax:301-759-4405
Practice Address - Street 1:952 SETON DR
Practice Address - Street 2:SUITE 104
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-1950
Practice Address - Country:US
Practice Address - Phone:301-759-4900
Practice Address - Fax:301-759-4405
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD100831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDDJ46OtherBLUE CROSS BLUE SHIELD MD