Healthcare Provider Details

I. General information

NPI: 1184808396
Provider Name (Legal Business Name): JOHN ALEXANDER KENNEDY JR. D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/24/2007
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2311 WOODRUFF RD
SIMPSONVILLE SC
29681-5442
US

IV. Provider business mailing address

PO BOX 31625
GREENVILLE SC
29608-1625
US

V. Phone/Fax

Practice location:
  • Phone: 864-501-9800
  • Fax:
Mailing address:
  • Phone: 864-501-0070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4377
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: