Provider Demographics
NPI:1568489144
Name:KENNEDY, KEVIN FRANCIS (DDS)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:FRANCIS
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 1:7110 W 127TH ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1560
Mailing Address - Country:US
Mailing Address - Phone:708-448-7150
Mailing Address - Fax:708-448-6355
Practice Address - Street 1:7110 W 127TH ST
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1560
Practice Address - Country:US
Practice Address - Phone:708-448-7150
Practice Address - Fax:708-448-6355
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19148881223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT37292Medicare UPIN
IL616370Medicare ID - Type Unspecified