Healthcare Provider Details

I. General information

NPI: 1497686794
Provider Name (Legal Business Name): VICTORIA ANN KENNEDY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10001 WASHINGTON ST STE D
THORNTON CO
80229-2031
US

IV. Provider business mailing address

2556 W 110TH PL
WESTMINSTER CO
80234-3102
US

V. Phone/Fax

Practice location:
  • Phone: 720-706-9880
  • Fax:
Mailing address:
  • Phone: 970-405-0807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number00206660
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: