Provider Demographics
NPI:1073341103
Name:KENNEDY R DELE, DMD PC
Entity type:Organization
Organization Name:KENNEDY R DELE, DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNEDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DELE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-571-5014
Mailing Address - Street 1:161 JENNIFER RD STE B
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3367
Mailing Address - Country:US
Mailing Address - Phone:410-571-5014
Mailing Address - Fax:410-571-5409
Practice Address - Street 1:161 JENNIFER RD STE B
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3367
Practice Address - Country:US
Practice Address - Phone:410-571-5014
Practice Address - Fax:410-571-5409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty