MEDICARE: DR. ROBERT FORD KENNEDY

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	16790	CA

General Provider Information

NPI Number	:	1720197536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT FORD KENNEDY

Provider Business Mailing Address
First Line	:	3524 SPRINGHILL RD
Second Line	:
City	:	LAFAYETTE
State	:	CA
Zip	:	94549-2536
Country	:	US
Telephone Number	:	925-284-2635
Fax Number	:	925-284-2685

Provider Business Practice Location Address
First Line	:	3505 LONE TREE WAY
Second Line	:	7
City	:	ANTIOCH
State	:	CA
Zip	:	94509-6067
Country	:	US
Telephone Number	:	925-756-7884
Fax Number	:	925-756-7890

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

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	07/08/2007

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