Provider Demographics
NPI:1629716659
Name:JARED S. KENWOOD, DDS, PC
Entity Type:Organization
Organization Name:JARED S. KENWOOD, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:S
Authorized Official - Last Name:KENWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:215-493-1616
Mailing Address - Street 1:301 OXFORD VALLEY RD STE 404A
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-7710
Mailing Address - Country:US
Mailing Address - Phone:215-493-1616
Mailing Address - Fax:
Practice Address - Street 1:301 OXFORD VALLEY RD STE 404A
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-7710
Practice Address - Country:US
Practice Address - Phone:215-493-1616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA35547Medicaid