Provider Demographics
NPI:1932232329
Name:KENNEDY, BARRY (DDS)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 HITCHING POST LN
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-2064
Mailing Address - Country:US
Mailing Address - Phone:770-623-4661
Mailing Address - Fax:
Practice Address - Street 1:3772 SATELLITE BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-5681
Practice Address - Country:US
Practice Address - Phone:770-623-4661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA86811223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics