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General NPI Number Information
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NPI Number | 1447373071
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Entity Type | Individual
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Provider Name | JAMES EDWARD KENNEDY DMD MS
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Gender | Male
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Dates
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Enumeration Date | 04/09/2007
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Last Update Date | 07/11/2013
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Provider Practice Location Address
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Address Line | 910 WILLISTON PARK PT STE 1050
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City | LAKE MARY
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State | FL
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Zip | 32746-2107
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Country | US
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Telephone | 407-833-8522
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Fax | 407-833-8523
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Provider Business Mailing Address
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Address Line | 455 GOLF BROOK LN APT 103
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City | LONGWOOD
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State | FL
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Zip | 32779-6104
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Country | US
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Telephone | 407-833-8522
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Fax | 407-833-8523
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DN15259
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License Number State | FL
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