# KENNEDY DENTAL OFFICE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1447311451
- **Authorized official:** MRS. KIMBERLY A. DILLON (ACCOUNT MANAGER)
- **Authorized official phone:** (304) 744-9717

## Contact information

- **Practice address:** 410 4TH AVE, MONTGOMERY, WV 25136-2105
- **Practice address phone:** (304) 442-2488
- **Practice address fax:** (304) 442-8835
- **Mailing address:** 410 4TH AVE, MONTGOMERY, WV 25136-2105
- **Mailing address phone:** (304) 442-2488
- **Mailing address fax:** (304) 442-8835

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 12/13/2006
- **Last updated:** 08/22/2020