MEDICARE: KENNEDY & RICHARDSON DENTAL OFFICE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1003850256
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENNEDY & RICHARDSON DENTAL OFFICE

Provider Business Mailing Address
First Line	:	1000 PARKWAY RD
Second Line	:	STE. D
City	:	CHARLESTON
State	:	WV
Zip	:	25309-9418
Country	:	US
Telephone Number	:	304-744-9717
Fax Number	:	304-744-9733

Provider Business Practice Location Address
First Line	:	1000 PARKWAY RD
Second Line	:	STE. D
City	:	CHARLESTON
State	:	WV
Zip	:	25309-9418
Country	:	US
Telephone Number	:	304-744-9717
Fax Number	:	304-744-9733

Authorized Official
Title or Position	:	ACCOUNT MANAGER
Name	:	MRS. KIMBERLY ANN DILLON
Credential	:
Telephone Number	:	304-744-9717

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	08/22/2020

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Directions to “KENNEDY & RICHARDSON DENTAL OFFICE ” Practice Location

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