Provider Demographics
NPI:1720197536
Name:KENNEDY, ROBERT FORD
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:FORD
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3524 SPRINGHILL RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-2536
Mailing Address - Country:US
Mailing Address - Phone:925-284-2635
Mailing Address - Fax:925-284-2685
Practice Address - Street 1:3505 LONE TREE WAY
Practice Address - Street 2:7
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-6067
Practice Address - Country:US
Practice Address - Phone:925-756-7884
Practice Address - Fax:925-756-7890
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA167901223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics