MEDICARE: RILEY 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	8202	OK

General Provider Information

NPI Number	:	1821927799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RILEY KENNEDY DDS

Provider Business Mailing Address
First Line	:	7325 NW 113TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73162-2748
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1705 W ELM ST
Second Line	:
City	:	EL RENO
State	:	OK
Zip	:	73036-4203
Country	:	US
Telephone Number	:	405-262-2289
Fax Number	:

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

Provider Enumeration Date	:	05/18/2026
Last Update Date	:	05/18/2026

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Directions to “ RILEY KENNEDY DDS” Practice Location

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