Healthcare Provider Details

I. General information

NPI: 1225020464
Provider Name (Legal Business Name): KATHLEEN SUSAN KENNY D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NATIONAL NAVAL MEDICAL CENTER 8901 WISCONSIN AVE.
BETHESDA MD
20889-0001
US

IV. Provider business mailing address

8801 FALLS CHAPEL WAY
POTOMAC MD
20854-2347
US

V. Phone/Fax

Practice location:
  • Phone: 301-319-4649
  • Fax: 301-295-5767
Mailing address:
  • Phone: 301-838-0523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number0401006946
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: