Provider Demographics
NPI:1740370840
Name:KEMP MILL DENTAL
Entity type:Organization
Organization Name:KEMP MILL DENTAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:A
Authorized Official - Last Name:GAKNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-649-1361
Mailing Address - Street 1:1299 LAMBERTON DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-3411
Mailing Address - Country:US
Mailing Address - Phone:301-649-1361
Mailing Address - Fax:301-649-3221
Practice Address - Street 1:1299 LAMBERTON DR
Practice Address - Street 2:SUITE A
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-3411
Practice Address - Country:US
Practice Address - Phone:301-649-1361
Practice Address - Fax:301-649-3221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10996122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty