Provider Demographics
NPI:1316670326
Name:KENNEDY, CARA LYNN (DMD)
Entity type:Individual
Prefix:
First Name:CARA
Middle Name:LYNN
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:CARA
Other - Middle Name:
Other - Last Name:KROHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7310 ANTOINETTE WAY APT 401
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-5985
Mailing Address - Country:US
Mailing Address - Phone:412-523-5612
Mailing Address - Fax:
Practice Address - Street 1:110 INDUSTRIAL PARK LN
Practice Address - Street 2:
Practice Address - City:ROCKY TOP
Practice Address - State:TN
Practice Address - Zip Code:37769-2300
Practice Address - Country:US
Practice Address - Phone:865-426-7421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000118051223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics