Provider Demographics
NPI:1568601698
Name:KENT COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:KENT COUNTY HEALTH DEPARTMENT
Other - Org Name:KENT COUNTY HEALTH DEPARTMENT CHILDREN'S DENTAL HEALTH PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:FISCAL TECH.
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:ASHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-778-2103
Mailing Address - Street 1:125 S LYNCHBURG ST
Mailing Address - Street 2:
Mailing Address - City:CHESTERTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21620-1146
Mailing Address - Country:US
Mailing Address - Phone:410-778-2103
Mailing Address - Fax:
Practice Address - Street 1:125 S LYNCHBURG ST
Practice Address - Street 2:
Practice Address - City:CHESTERTOWN
Practice Address - State:MD
Practice Address - Zip Code:21620-1146
Practice Address - Country:US
Practice Address - Phone:410-778-2103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-12
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0027046251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare