# KELLY A. HENNESSEY D.D.S., PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Manito Family Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710634670
- **Authorized official:** KELLY A HENNESSEY DDS (DENTIST/OWNER)
- **Authorized official phone:** (509) 714-5757

## Contact information

- **Practice address:** 3615 S GRAND BLVD, SPOKANE, WA 99203-2624
- **Practice address phone:** (509) 456-8676
- **Practice address fax:** (509) 465-8676
- **Mailing address:** 3615 S GRAND BLVD, SPOKANE, WA 99203-2624
- **Mailing address phone:** (509) 456-8676
- **Mailing address fax:** (509) 465-8676

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 03/09/2022
- **Last updated:** 03/09/2022