Provider Demographics
NPI:1083814206
Name:MONICA KENNARD,D.D.S.,P.A.
Entity Type:Organization
Organization Name:MONICA KENNARD,D.D.S.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:A
Authorized Official - Last Name:KENNARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-475-3135
Mailing Address - Street 1:250 CENTRAL AVE N
Mailing Address - Street 2:SUITE 211
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-1208
Mailing Address - Country:US
Mailing Address - Phone:952-475-3135
Mailing Address - Fax:952-475-1936
Practice Address - Street 1:250 CENTRAL AVE N
Practice Address - Street 2:SUITE 211
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-1208
Practice Address - Country:US
Practice Address - Phone:952-475-3135
Practice Address - Fax:952-475-1936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN107801223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty