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DR. KELLY SUE KENNEDY D.D.S. NPI 1568673366


NPI Information

NPI: 1568673366
Provider Name: DR. KELLY SUE KENNEDY, D.D.S.
Classification: Oral & Maxillofacial Surgery - 204E00000X
Entity Type: Individual

PECOS Registration: Yes

Address:
305 W 12TH AVE
DENTAL FACULTY PRACTICE
COLUMBUS, OH
ZIP 43210
Phone: (614) 292-5574
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DR. Kelly Sue Kennedy, D.D.S. is an oral maxillofacial surgery in Columbus, OH with 16 years of experience. The provider is oral and maxillofacial surgeons are trained to recognize and treat a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region. They are also trained to administer anesthesia, and provide care in an office setting. They are trained to treat problems such as the extraction of wisdom teeth, misaligned jaws, tumors and cysts of the jaw and mouth, and to perform dental implant surgery. DR. Kelly Sue Kennedy, D.D.S. NPI is 1568673366. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

305 W 12TH AVE
DENTAL FACULTY PRACTICE
COLUMBUS, OH
ZIP 43210-267
Phone: (614) 292-5574
Fax: (614) 292-9472

The NPI 1568673366 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 5/24/2007 and was last updated on 12/19/2019.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
11223S0112XDentistOral and Maxillofacial Surgery2322OHIONo
21223S0112XDentistOral and Maxillofacial Surgery30-022717OHIONo
3204E00000XOral & Maxillofacial Surgery30.022717OHIOYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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