Provider Demographics
NPI:1235721101
Name:THOMAS KENNEDY, DDS OF LOUISIANA II, A PROFESSIONAL DENTAL LLC
Entity Type:Organization
Organization Name:THOMAS KENNEDY, DDS OF LOUISIANA II, A PROFESSIONAL DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENROLLMENT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:HALEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-733-8551
Mailing Address - Street 1:3203 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-2220
Mailing Address - Country:US
Mailing Address - Phone:225-298-3200
Mailing Address - Fax:
Practice Address - Street 1:3203 S SHERWOOD FOREST BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-2220
Practice Address - Country:US
Practice Address - Phone:225-298-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-10
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty