MEDICARE: BARRY A KENNEDY 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	1223G0001X	General Practice Dentistry	2791	NV

General Provider Information

NPI Number	:	1598799009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARRY A KENNEDY D.D.S

Provider Business Mailing Address
First Line	:	4818 W LONE MOUNTAIN RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-2239
Country	:	US
Telephone Number	:	702-655-9533
Fax Number	:	702-655-9565

Provider Business Practice Location Address
First Line	:	4818 W LONE MOUNTAIN RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-2239
Country	:	US
Telephone Number	:	702-655-9533
Fax Number	:	702-655-9565

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	03/30/2015

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