Provider Demographics
NPI:1528030152
Name:KENNEDY, RICHARD L (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
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 1:531 CENTRAL PARK AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-1018
Mailing Address - Country:US
Mailing Address - Phone:914-472-7887
Mailing Address - Fax:
Practice Address - Street 1:531 CENTRAL PARK AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-1018
Practice Address - Country:US
Practice Address - Phone:914-472-7887
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0413771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice