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General NPI Number Information
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NPI Number | 1942393038
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Entity Type | Individual
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Provider Name | WAYNE W KEARNEY D.D.S., M.S., P.A.
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Gender | Male
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2179 JULIAN AVE NE SUITE 1
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City | PALM BAY
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State | FL
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Zip | 32905-4042
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Country | US
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Telephone | 321-952-1625
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Fax | 321-952-0255
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Provider Business Mailing Address
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Address Line | 2179 JULIAN AVE NE SUITE 1
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City | PALM BAY
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State | FL
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Zip | 32905-4042
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Country | US
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Telephone | 321-952-1625
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Fax | 321-952-0255
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 7915
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License Number State | MI
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