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General NPI Number Information
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NPI Number | 1407049612
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Entity Type | Organization
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Legal Business Name | KENNEDY FAMILY DENTISTRY, INC
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Dates
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Enumeration Date | 08/21/2007
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Last Update Date | 07/31/2008
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Provider Practice Location Address
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Address Line | 1611 EXECUTIVE CT STE 200
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City | SACRAMENTO
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State | CA
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Zip | 95864-2648
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Country | US
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Telephone | 916-487-5160
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Fax |
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Provider Business Mailing Address
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Address Line | 1611 EXECUTIVE CT STE 200
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City | SACRAMENTO
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State | CA
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Zip | 95864-2648
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Country | US
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Telephone | 916-487-5160
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. TIFFANY MONIQUE SETTLE
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Credential | OM
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Telephone | 916-487-5152
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 35625
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License Number State | CA
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