Provider Demographics
NPI:1295767903
Name:KENNEDY JR, PAUL A (DDS)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:A
Last Name:KENNEDY JR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:PAUL
Other - Middle Name:A
Other - Last Name:KENNEDY JR INC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6200 SARATOGA BLVD BLDG 1
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-3421
Mailing Address - Country:US
Mailing Address - Phone:361-992-9500
Mailing Address - Fax:361-992-1862
Practice Address - Street 1:6200 SARATOGA BLVD BLDG 1
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-3421
Practice Address - Country:US
Practice Address - Phone:361-992-9500
Practice Address - Fax:361-992-1862
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84451223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry