Provider Demographics
NPI:1720008568
Name:PAUL A KENNEDY, JR., D.D.S., INC
Entity Type:Organization
Organization Name:PAUL A KENNEDY, JR., D.D.S., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:361-992-9500
Mailing Address - Street 1:6200 SARATOGA BLVD
Mailing Address - Street 2:BUILDING 1
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-3477
Mailing Address - Country:US
Mailing Address - Phone:361-992-9500
Mailing Address - Fax:361-992-1862
Practice Address - Street 1:6200 SARATOGA BLVD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-3421
Practice Address - Country:US
Practice Address - Phone:361-992-9500
Practice Address - Fax:361-992-1862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84451223P0221X, 1223S0112X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty