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Individual
DR. KEITH D KENNEDY
Active
Individual
DR. KEITH D KENNEDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D5671
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1689938
UNITED CONCORDIA
AZ
01
—
201797682
TAX ID #
AZ
01
—
895401
AHCCCS
AZ
01
—
AZ0413330
BLUE CROSS BLUE SHIELD
AZ
Enumeration date
12/08/2006
Last updated
10/05/2023
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