Provider Demographics
NPI:1225311905
Name:CHRISTOPHER W. KENNERLY, D.D.S. & JEREMY W. LEDFORD, D.M.D., P.A.
Entity Type:Organization
Organization Name:CHRISTOPHER W. KENNERLY, D.D.S. & JEREMY W. LEDFORD, D.M.D., P.A.
Other - Org Name:ASHEVILLE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:W
Authorized Official - Last Name:LEDFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:828-277-9907
Mailing Address - Street 1:10 YORKSHIRE ST STE C
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2752
Mailing Address - Country:US
Mailing Address - Phone:828-277-9907
Mailing Address - Fax:828-277-6445
Practice Address - Street 1:10 YORKSHIRE ST STE C
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2752
Practice Address - Country:US
Practice Address - Phone:828-277-9907
Practice Address - Fax:828-277-6445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC87901223G0001X
NC46571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty