Provider Demographics
NPI:1255584280
Name:HENKEN & KENNEDY ORTHODONTIC DENTAL GROUP
Entity type:Organization
Organization Name:HENKEN & KENNEDY ORTHODONTIC DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:949-661-3336
Mailing Address - Street 1:1171 PUERTA DEL SOL
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-6343
Mailing Address - Country:US
Mailing Address - Phone:949-661-3336
Mailing Address - Fax:949-366-0094
Practice Address - Street 1:1171 PUERTA DEL SOL
Practice Address - Street 2:SUITE B
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-6343
Practice Address - Country:US
Practice Address - Phone:949-661-3336
Practice Address - Fax:949-366-0094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA513461223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty