Provider Demographics
NPI:1790767788
Name:KENNEDY, JAMES HENRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:HENRY
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 1:100 S CHERRY AVE
Mailing Address - Street 2:UNIT 2 SUITE A
Mailing Address - City:EATON
Mailing Address - State:CO
Mailing Address - Zip Code:80615-8253
Mailing Address - Country:US
Mailing Address - Phone:970-454-3341
Mailing Address - Fax:970-454-3393
Practice Address - Street 1:100 S CHERRY AVE
Practice Address - Street 2:UNIT 2 SUITE A
Practice Address - City:EATON
Practice Address - State:CO
Practice Address - Zip Code:80615-8253
Practice Address - Country:US
Practice Address - Phone:970-454-3341
Practice Address - Fax:970-454-3393
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8230122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist