Provider Demographics
NPI:1073063830
Name:KIRSTEN WILLIAM-KENNEDY DDS, MS, P.C.
Entity Type:Organization
Organization Name:KIRSTEN WILLIAM-KENNEDY DDS, MS, P.C.
Other - Org Name:DEDICATED DENTAL SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAM-KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:605-341-0826
Mailing Address - Street 1:740 SHERIDAN LK. RD. SUITE A
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702
Mailing Address - Country:US
Mailing Address - Phone:605-341-0826
Mailing Address - Fax:605-341-1153
Practice Address - Street 1:740 SHERIDAN LK. RD. SUITE A
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702
Practice Address - Country:US
Practice Address - Phone:605-341-0826
Practice Address - Fax:605-341-1153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-05
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM721122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty