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General NPI Number Information
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NPI Number | 1104238716
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Entity Type | Individual
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Provider Name | JARED KENNEY DDS
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Gender | Male
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Dates
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Enumeration Date | 05/30/2014
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Last Update Date | 12/28/2024
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Provider Practice Location Address
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Address Line | 21300 N JOHN WAYNE PKWY STE 114
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City | MARICOPA
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State | AZ
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Zip | 85139
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Country | US
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Telephone | 520-231-6700
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Fax | 520-208-9066
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Provider Business Mailing Address
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Address Line | 3232 E REDWOOD LN
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City | PHOENIX
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State | AZ
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Zip | 85048-7834
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Country | US
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Telephone | 916-204-8762
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | D009960
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License Number State | AZ
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