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General NPI Number Information
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NPI Number | 1285720391
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Entity Type | Individual
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Provider Name | RICHARD GEORGE KENNEDY D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 06/24/2010
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Provider Practice Location Address
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Address Line | 27180 NEWPORT ROAD SUITE 1
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City | MENIFEE
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State | CA
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Zip | 92584-2248
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Country | US
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Telephone | 951-679-9355
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Fax | 951-301-0130
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Provider Business Mailing Address
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Address Line | 27180 NEWPORT RD STE 1
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City | MENIFEE
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State | CA
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Zip | 92584-7389
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Country | US
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Telephone | 951-679-9355
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Fax | 951-301-0130
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 34502
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License Number State | CA
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