Provider Demographics
NPI:1316953268
Name:KENNARD, MONICA ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:MONICA
Middle Name:ANN
Last Name:KENNARD
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 1:4449 SW TWOMBLY AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-1372
Mailing Address - Country:US
Mailing Address - Phone:503-894-8065
Mailing Address - Fax:
Practice Address - Street 1:2824 NE WASCO ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1772
Practice Address - Country:US
Practice Address - Phone:503-284-5678
Practice Address - Fax:503-284-5556
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD92031223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry