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General NPI Number Information
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NPI Number | 1497162358
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Entity Type | Individual
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Provider Name | NICHOLAS RYAN KENNING D.D.S., M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/11/2014
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Last Update Date | 06/25/2020
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Provider Practice Location Address
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Address Line | 3950 VETERANS DR STE 100
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City | SAINT CLOUD
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State | MN
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Zip | 56303-3424
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Country | US
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Telephone | 320-252-3611
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Fax | 320-252-7574
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Provider Business Mailing Address
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Address Line | 3950 VETERANS DR STE 100
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City | SAINT CLOUD
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State | MN
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Zip | 56303-3424
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Country | US
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Telephone | 320-252-3611
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Fax | 320-252-7574
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 64354
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | D13402
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | D13402
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License Number State | MN
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Taxonomy #4
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 64354
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License Number State | MN
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