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NPI Code Detail

MEDICARE: DR. KIMANH KENNELLY DDS

MEDICARE: DR. KIMANH KENNELLY 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
11223G0001XGeneral Practice Dentistry055527NY
21223G0001XGeneral Practice Dentistry201957CO

General Provider Information

NPI Number : 1760770143
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KIMANH KENNELLY DDS
Provider Business Mailing Address
First Line : 3146 S GENEVA ST
Second Line :
City : DENVER
State : CO
Zip : 80231-4733
Country : US
Telephone Number : 585-899-0124
Fax Number :
Provider Business Practice Location Address
First Line : 12999 W BOWLES DR
Second Line :
City : LITTLETON
State : CO
Zip : 80127-4641
Country : US
Telephone Number : 303-989-9010
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2011
Last Update Date : 12/14/2016

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