Provider Demographics
NPI:1659468510
Name:KENNEDY, JAMES MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MICHAEL
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 1:1190 BOOKCLIFF AVE
Mailing Address - Street 2:#101
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-8133
Mailing Address - Country:US
Mailing Address - Phone:970-242-1900
Mailing Address - Fax:970-242-1988
Practice Address - Street 1:1190 BOOKCLIFF AVE
Practice Address - Street 2:#101
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-8133
Practice Address - Country:US
Practice Address - Phone:970-242-1900
Practice Address - Fax:970-242-1988
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO76301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice