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General NPI Number Information
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NPI Number | 1558311951
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Entity Type | Individual
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Provider Name | RICHARD W. KENNEDY DMD
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Gender | Male
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 1246 NILLES RD SUITE 3
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City | FAIRFIELD
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State | OH
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Zip | 45014-2912
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Country | US
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Telephone | 513-858-6575
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Fax |
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Provider Business Mailing Address
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Address Line | 1246 NILLES RD SUITE 3
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City | FAIRFIELD
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State | OH
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Zip | 45014-2912
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Country | US
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Telephone | 513-858-6575
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Fax |
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 30016014
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License Number State | OH
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