MEDICARE: PAUL KENWORTHY DMD, PC

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	122300000X	Dentist	016-0000975	VT

General Provider Information

NPI Number	:	1043481625
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAUL KENWORTHY DMD, PC

Provider Business Mailing Address
First Line	:	4 KELLOGG ROAD
Second Line	:
City	:	ESSEX JCT.
State	:	VT
Zip	:	05452-2815
Country	:	US
Telephone Number	:	802-879-5151
Fax Number	:	866-561-8426

Provider Business Practice Location Address
First Line	:	4 KELLOGG ROAD
Second Line	:
City	:	ESSEX JCT.
State	:	VT
Zip	:	05452-2815
Country	:	US
Telephone Number	:	802-879-5151
Fax Number	:	866-561-8426

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	DR. PAUL FRANCIS KENWORTHY
Credential	:	DMD
Telephone Number	:	802-879-5151

Provider Enumeration Date	:	03/21/2008
Last Update Date	:	10/26/2015

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