MEDICARE: DR. JAMES EDWARD KENNEDY DMD MS

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	1223P0300X	Periodontics	DN15259	FL

General Provider Information

NPI Number	:	1447373071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES EDWARD KENNEDY DMD MS

Provider Business Mailing Address
First Line	:	455 GOLF BROOK LN APT 103
Second Line	:
City	:	LONGWOOD
State	:	FL
Zip	:	32779-6104
Country	:	US
Telephone Number	:	407-833-8522
Fax Number	:	407-833-8523

Provider Business Practice Location Address
First Line	:	910 WILLISTON PARK PT STE 1050
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-2107
Country	:	US
Telephone Number	:	407-833-8522
Fax Number	:	407-833-8523

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

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	07/11/2013

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