MEDICARE: KENNER DENTAL COMPANY LLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1689547903
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENNER DENTAL COMPANY LLC

Provider Business Mailing Address
First Line	:	1341 BURGESS DR
Second Line	:
City	:	MARRERO
State	:	LA
Zip	:	70072-5978
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4501 WILLIAMS BOULEVARD
Second Line	:	SUITE A
City	:	KENNER
State	:	LA
Zip	:	70065
Country	:	US
Telephone Number	:	504-273-0105
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BRANFORD SMITH
Credential	:	DDS
Telephone Number	:	504-234-9180

Provider Enumeration Date	:	09/24/2025
Last Update Date	:	09/24/2025

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Directions to “KENNER DENTAL COMPANY LLC ” Practice Location

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