Provider Demographics
NPI:1093350084
Name:KENNEDY UPPERMAN FAMILY DENTISTRY AND ORTHODONTICS LLC
Entity Type:Organization
Organization Name:KENNEDY UPPERMAN FAMILY DENTISTRY AND ORTHODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-701-8171
Mailing Address - Street 1:624 CENTRAL CTR
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-2248
Mailing Address - Country:US
Mailing Address - Phone:740-773-4166
Mailing Address - Fax:
Practice Address - Street 1:624 CENTRAL CTR
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-2248
Practice Address - Country:US
Practice Address - Phone:740-773-4166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-13
Last Update Date:2020-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental