Provider Demographics
NPI:1497162358
Name:KENNING, NICHOLAS RYAN (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:RYAN
Last Name:KENNING
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
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Mailing Address - Street 1:3950 VETERANS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-3424
Mailing Address - Country:US
Mailing Address - Phone:320-252-3611
Mailing Address - Fax:320-252-7574
Practice Address - Street 1:3950 VETERANS DR STE 100
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-3424
Practice Address - Country:US
Practice Address - Phone:320-252-3611
Practice Address - Fax:320-252-7574
Is Sole Proprietor?:No
Enumeration Date:2014-07-11
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN643541223S0112X, 204E00000X
MND134021223S0112X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery