Healthcare Provider Details

I. General information

NPI: 1821927799
Provider Name (Legal Business Name): RILEY KENNEDY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 W ELM ST
EL RENO OK
73036-4203
US

IV. Provider business mailing address

7325 NW 113TH ST
OKLAHOMA CITY OK
73162-2748
US

V. Phone/Fax

Practice location:
  • Phone: 405-262-2289
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8202
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: