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General NPI Number Information
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NPI Number | 1154196848
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Entity Type | Individual
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Provider Name | JACOB KENNEDY DDS
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Gender | Male
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Dates
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Enumeration Date | 11/22/2023
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 620 E 8TH ST
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City | PORT ANGELES
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State | WA
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Zip | 98362-6224
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Country | US
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Telephone | 360-216-6166
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Fax |
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Provider Business Mailing Address
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Address Line | 756 HIGH COUNTRY DR
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City | PORT ANGELES
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State | WA
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Zip | 98362-7493
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Country | US
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Telephone | 360-216-6166
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 70017745
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License Number State | WA
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