MEDICARE: DR. KEVIN PATRICK MCKENNA D.D.S.

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	1223P0221X	Pediatric Dentistry	LDR160152	IN

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	:	1295185619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN PATRICK MCKENNA D.D.S.

Provider Business Mailing Address
First Line	:	1947 E MILITARY AVE
Second Line	:
City	:	FREMONT
State	:	NE
Zip	:	68025-5467
Country	:	US
Telephone Number	:	402-727-8700
Fax Number	:	402-727-8705

Provider Business Practice Location Address
First Line	:	1947 E MILITARY AVE
Second Line	:
City	:	FREMONT
State	:	NE
Zip	:	68025-5467
Country	:	US
Telephone Number	:	402-727-8700
Fax Number	:	402-727-8705

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

Provider Enumeration Date	:	06/16/2016
Last Update Date	:	01/07/2022

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