MEDICARE: KENNETH CARROLL KENNEDY DDS

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	2659	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225157738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH CARROLL KENNEDY DDS

Provider Business Mailing Address
First Line	:	1511 VILLAGE CROSSING DR
Second Line	:
City	:	CHAPEL HILL
State	:	NC
Zip	:	27517-7575
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	427 MEADOWMONT VILLAGE CIR
Second Line	:
City	:	CHAPEL HILL
State	:	NC
Zip	:	27517-7506
Country	:	US
Telephone Number	:	919-969-9330
Fax Number	:	919-969-2774

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	04/12/2026

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