MEDICARE: DR. PAUL ALEXANDER KENNEDY III DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	20778	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376568469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL ALEXANDER KENNEDY III DDS

Provider Business Mailing Address
First Line	:	6200 SARATOGA BLVD
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78414-3421
Country	:	US
Telephone Number	:	361-992-9500
Fax Number	:	361-992-1862

Provider Business Practice Location Address
First Line	:	6200 SARATOGA BLVD
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78414-3421
Country	:	US
Telephone Number	:	361-992-9500
Fax Number	:	361-992-1862

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	12/15/2021

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