Provider Demographics
NPI:1831410653
Name:KENNEDY, PATRICK (DDS)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3312 HUDSON AVE APT 7J
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-5967
Mailing Address - Country:US
Mailing Address - Phone:917-420-0496
Mailing Address - Fax:
Practice Address - Street 1:3312 HUDSON AVE APT 7J
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-5967
Practice Address - Country:US
Practice Address - Phone:917-420-0496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190281031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice