Provider Demographics
NPI:1780738161
Name:MARTIN F KENNEDY DDS PC
Entity type:Organization
Organization Name:MARTIN F KENNEDY DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:F
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:812-883-2791
Mailing Address - Street 1:PO BOX 387
Mailing Address - Street 2:1600 S STATE RD 135
Mailing Address - City:SALEM
Mailing Address - State:IN
Mailing Address - Zip Code:47167-0387
Mailing Address - Country:US
Mailing Address - Phone:812-883-2791
Mailing Address - Fax:812-883-4007
Practice Address - Street 1:1600 S STATE RD 135
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IN
Practice Address - Zip Code:47167
Practice Address - Country:US
Practice Address - Phone:812-883-2791
Practice Address - Fax:812-883-4007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12006202122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty