Provider Demographics
NPI:1295185619
Name:MCKENNA, KEVIN PATRICK (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:PATRICK
Last Name:MCKENNA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1947 E MILITARY AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-5467
Mailing Address - Country:US
Mailing Address - Phone:402-727-8700
Mailing Address - Fax:402-727-8705
Practice Address - Street 1:1947 E MILITARY AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-5467
Practice Address - Country:US
Practice Address - Phone:402-727-8700
Practice Address - Fax:402-727-8705
Is Sole Proprietor?:No
Enumeration Date:2016-06-16
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INLDR1601521223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
INLDR160152Medicaid