# DR. KELLY SUE KENNEDY

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1568673366
- **Gender:** F
- **Credential:** D.D.S.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 2322 | OH | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 30-022717 | OH | — |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | 30.022717 | OH | Yes |

## Other

- **Enumeration date:** 05/24/2007
- **Last updated:** 12/19/2019