Provider Demographics
NPI:1063721819
Name:KENNEDY, JEAN (DDS)
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6351 US ROUTE 60 E
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-1233
Mailing Address - Country:US
Mailing Address - Phone:304-736-9232
Mailing Address - Fax:304-736-9220
Practice Address - Street 1:6351 US ROUTE 60 E
Practice Address - Street 2:SUITE 5
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-1233
Practice Address - Country:US
Practice Address - Phone:304-736-9232
Practice Address - Fax:304-736-9220
Is Sole Proprietor?:No
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV29001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice