Provider Demographics
NPI:1760770143
Name:KENNELLY, KIMANH (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIMANH
Middle Name:
Last Name:KENNELLY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3146 S GENEVA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-4733
Mailing Address - Country:US
Mailing Address - Phone:585-899-0124
Mailing Address - Fax:
Practice Address - Street 1:12999 W BOWLES DR
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-4641
Practice Address - Country:US
Practice Address - Phone:303-989-9010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0555271223G0001X
CO2019571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice