Provider Demographics
NPI:1396932604
Name:FRED F KENNETT DDS PC
Entity type:Organization
Organization Name:FRED F KENNETT DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:FROST
Authorized Official - Last Name:KENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-330-4324
Mailing Address - Street 1:11453 ROBIOUS ROAD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235
Mailing Address - Country:US
Mailing Address - Phone:804-330-4324
Mailing Address - Fax:804-330-2799
Practice Address - Street 1:11453 ROBIOUS ROAD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235
Practice Address - Country:US
Practice Address - Phone:804-330-4324
Practice Address - Fax:804-330-2799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVA005807122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty