Provider Demographics
NPI:1114043288
Name:KENNEY, JOHN DAVID (MD DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DAVID
Last Name:KENNEY
Suffix:
Gender:M
Credentials:MD DDS
Other - Prefix:
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Mailing Address - Street 1:PO BOX 41123
Mailing Address - Street 2:MS 41123
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98504-1123
Mailing Address - Country:US
Mailing Address - Phone:360-725-8713
Mailing Address - Fax:360-586-9060
Practice Address - Street 1:7345 LINDERSON WAY SW
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-6504
Practice Address - Country:US
Practice Address - Phone:360-725-8713
Practice Address - Fax:360-586-9060
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD0022210208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice