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General NPI Number Information
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NPI Number | 1992987036
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Entity Type | Organization
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Legal Business Name | THOMAS JOHN KENNEDY OF MISSOURI, DDS, P.C.
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Dates
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Enumeration Date | 11/30/2007
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Last Update Date | 11/30/2007
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Provider Practice Location Address
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Address Line | 1708 MISSOURI STATE RD
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City | ARNOLD
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State | MO
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Zip | 63010-2006
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Country | US
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Telephone | 636-287-9331
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Fax |
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Provider Business Mailing Address
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Address Line | 1708 MISSOURI STATE RD
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City | ARNOLD
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State | MO
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Zip | 63010-2006
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Country | US
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Telephone | 636-287-9331
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | THOMAS J KENNEDY
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Credential | DDS
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Telephone | 800-658-2177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 011904
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License Number State | MO
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