Provider Demographics
NPI:1942393038
Name:KEARNEY, WAYNE W (DDS, MS, PA)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:W
Last Name:KEARNEY
Suffix:
Gender:M
Credentials:DDS, MS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2179 JULIAN AVE NE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-4042
Mailing Address - Country:US
Mailing Address - Phone:321-952-1625
Mailing Address - Fax:321-952-0255
Practice Address - Street 1:2179 JULIAN AVE NE
Practice Address - Street 2:SUITE 1
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-4042
Practice Address - Country:US
Practice Address - Phone:321-952-1625
Practice Address - Fax:321-952-0255
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI79151223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics