Provider Demographics
NPI:1669692968
Name:KELMENSON, JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:KELMENSON
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 1:7939 HONEYGO BLVD
Mailing Address - Street 2:SUITE 214
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-5992
Mailing Address - Country:US
Mailing Address - Phone:410-933-1099
Mailing Address - Fax:410-933-6616
Practice Address - Street 1:7939 HONEYGO BLVD
Practice Address - Street 2:SUITE 214
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-4931
Practice Address - Country:US
Practice Address - Phone:410-933-1099
Practice Address - Fax:410-933-6616
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD76431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice