Provider Demographics
NPI:1669462941
Name:JENNINGS, KEVIN D (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:D
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:211 PROVIDENCE RD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23325-4687
Mailing Address - Country:US
Mailing Address - Phone:757-523-9002
Mailing Address - Fax:757-523-9005
Practice Address - Street 1:211 PROVIDENCE RD
Practice Address - Street 2:SUITE 11
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23325-4687
Practice Address - Country:US
Practice Address - Phone:757-523-9002
Practice Address - Fax:757-523-9005
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA64441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA831824OtherUNITED CONCORDIA
VA0006147Medicaid
VA6444OtherDELTA DENTAL OF VA
VA028603OtherBLUE CROSS BLUE SHIELD
VA0005596256OtherAETNA