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General NPI Number Information
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NPI Number | 1669462941
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Entity Type | Individual
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Provider Name | KEVIN D JENNINGS DDS
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Gender | Male
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Dates
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Enumeration Date | 10/26/2005
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Last Update Date | 02/04/2008
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Provider Practice Location Address
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Address Line | 211 PROVIDENCE RD SUITE 11
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City | CHESAPEAKE
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State | VA
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Zip | 23325-4687
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Country | US
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Telephone | 757-523-9002
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Fax | 757-523-9005
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Provider Business Mailing Address
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Address Line | 211 PROVIDENCE RD SUITE 11
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City | CHESAPEAKE
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State | VA
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Zip | 23325-4687
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Country | US
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Telephone | 757-523-9002
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Fax | 757-523-9005
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6444
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License Number State | VA
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