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General NPI Number Information
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NPI Number | 1447649520
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Entity Type | Organization
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Legal Business Name | KENNEDY DENTISTRY
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Dates
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Enumeration Date | 01/13/2015
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Last Update Date | 01/13/2015
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Provider Practice Location Address
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Address Line | 4252 N VERRADO WAY STE 105
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City | BUCKEYE
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State | AZ
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Zip | 85396-7596
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Country | US
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Telephone | 623-594-8100
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Fax | 623-594-8120
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Provider Business Mailing Address
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Address Line | 4252 N VERRADO WAY STE 105
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City | BUCKEYE
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State | AZ
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Zip | 85396-7596
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Country | US
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Telephone | 623-594-8100
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Fax | 623-594-8120
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | EWA PLATACZ
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Credential |
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Telephone | 623-594-8100
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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 | 5910
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License Number State | AZ
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