Provider Demographics
NPI:1508975574
Name:KENNEDY, HAROLD D (DDS)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:D
Last Name:KENNEDY
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 1:2351 LARKSPUR LANE
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570
Mailing Address - Country:US
Mailing Address - Phone:337-948-9878
Mailing Address - Fax:337-948-9097
Practice Address - Street 1:2351 LARKSPUR LANE
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570
Practice Address - Country:US
Practice Address - Phone:337-948-9878
Practice Address - Fax:337-948-9097
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA46251223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1846252Medicaid
LA5CS43Medicare ID - Type Unspecified
U68760Medicare UPIN
LA5X392Medicare PIN