MEDICARE: JERRE L KENNEDY 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
1	1223G0001X	General Practice Dentistry	5504	NC

General Provider Information

NPI Number	:	1841319399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERRE L KENNEDY DDS

Provider Business Mailing Address
First Line	:	1246 HILLSBOROUGH RD
Second Line	:
City	:	CHAPEL HILL
State	:	NC
Zip	:	27516-8712
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	427 MEADOWMONT VILLAGE CIR
Second Line	:
City	:	CHAPEL HILL
State	:	NC
Zip	:	27517-7506
Country	:	US
Telephone Number	:	919-969-9330
Fax Number	:	919-969-2774

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

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	07/08/2007

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