MEDICARE: DANIEL JACOB KENNEDY 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	122300000X	Dentist	12814	MI

General Provider Information

NPI Number	:	1760562490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL JACOB KENNEDY DDS

Provider Business Mailing Address
First Line	:	2365 S HURON PKWY
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48104-5156
Country	:	US
Telephone Number	:	734-677-8700
Fax Number	:	734-839-4137

Provider Business Practice Location Address
First Line	:	2365 S HURON PKWY
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48104-5156
Country	:	US
Telephone Number	:	734-677-8700
Fax Number	:	734-839-4137

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	03/07/2023

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