Provider Demographics
NPI:1427313998
Name:KENNEDY, BROOKE LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:LEE
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 1:3091 COLLEGE PARK DR
Mailing Address - Street 2:STE 125
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77384-8024
Mailing Address - Country:US
Mailing Address - Phone:936-271-3338
Mailing Address - Fax:936-271-3320
Practice Address - Street 1:3091 COLLEGE PARK DR STE 125
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-8024
Practice Address - Country:US
Practice Address - Phone:936-271-3338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28091122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist