Provider Demographics
NPI:1437147535
Name:KENNEDY, PATRICK B (DMD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:B
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4133 TAYLOR BLVD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40215-2341
Mailing Address - Country:US
Mailing Address - Phone:502-368-8400
Mailing Address - Fax:502-368-8423
Practice Address - Street 1:4133 TAYLOR BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-2341
Practice Address - Country:US
Practice Address - Phone:502-368-8400
Practice Address - Fax:502-368-8423
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7958122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60002128Medicaid