=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558248245
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KERI KENNING DDS MSD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2025
-----------------------------------------------------
Last Update Date | 09/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 925 MAIN ST STE D
-----------------------------------------------------
City | BROOMFIELD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80020-1976
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-469-4191
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 925 MAIN ST STE D
-----------------------------------------------------
City | BROOMFIELD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80020-1976
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-664-1296
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR/OWNER
-----------------------------------------------------
Name | DR. KERI KENNING
-----------------------------------------------------
Credential | DDS MSD
-----------------------------------------------------
Telephone | 620-664-1296
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------