Healthcare Provider Details

I. General information

NPI: 1629906607
Provider Name (Legal Business Name): KENEDI LYNN HOLCK DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 NW CHIPMAN RD
LEES SUMMIT MO
64081-3934
US

IV. Provider business mailing address

2645 PARK PLACE CIR
FREMONT NE
68025-3793
US

V. Phone/Fax

Practice location:
  • Phone: 816-600-3722
  • Fax:
Mailing address:
  • Phone: 402-620-5916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: