Provider Demographics
NPI:1144216599
Name:KENNADY, MONTA CUTBIRTH (DDS)
Entity Type:Individual
Prefix:DR
First Name:MONTA
Middle Name:CUTBIRTH
Last Name:KENNADY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 EMERALD PLAZA
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-1501
Mailing Address - Country:US
Mailing Address - Phone:979-764-7101
Mailing Address - Fax:979-764-7115
Practice Address - Street 1:1505 EMERALD PLAZA
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-1501
Practice Address - Country:US
Practice Address - Phone:979-764-7101
Practice Address - Fax:979-764-7115
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX140371223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX090288402Medicaid
TX813315OtherUNITED CONCORDIA
TX84V342OtherBLUE CROSS BLUE SHIELD
TX84V342Medicare ID - Type Unspecified
TX84V342OtherBLUE CROSS BLUE SHIELD