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General NPI Number Information
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NPI Number | 1376152991
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Entity Type | Individual
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Provider Name | BRIAN JOSEPH KENNEDY DDS
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Gender | Male
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Dates
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Enumeration Date | 07/29/2020
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Last Update Date | 07/29/2020
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Provider Practice Location Address
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Address Line | 1900 W CHANDLER BLVD STE 22
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City | CHANDLER
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State | AZ
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Zip | 85224-6175
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Country | US
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Telephone | 480-681-1946
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Fax |
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Provider Business Mailing Address
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Address Line | 3250 S ARIZONA AVE APT 3034
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City | CHANDLER
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State | AZ
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Zip | 85248-2739
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Country | US
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Telephone | 310-701-5027
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | PD0032
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License Number State | AZ
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