Provider Demographics
NPI:1912070590
Name:KENNEDY, SANDRA HUEBSCH (D,D,S,)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:HUEBSCH
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:D,D,S,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11800 ABERDEEN ST NE STE 110
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-4812
Mailing Address - Country:US
Mailing Address - Phone:763-786-4280
Mailing Address - Fax:763-754-6226
Practice Address - Street 1:11800 ABERDEEN ST NE STE 110
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-4812
Practice Address - Country:US
Practice Address - Phone:763-786-4280
Practice Address - Fax:763-754-6226
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND10866122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist