Provider Demographics
NPI:1437263878
Name:KENNEDY, KAREN ARMSTRONG (DMD)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:ARMSTRONG
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:ARMSTRONG
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:204 SMITH ST.
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240
Mailing Address - Country:US
Mailing Address - Phone:706-884-4254
Mailing Address - Fax:706-884-2239
Practice Address - Street 1:204 SMITH ST.
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240
Practice Address - Country:US
Practice Address - Phone:706-884-4254
Practice Address - Fax:706-884-2239
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11604122300000X
GADNO11604122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist