# JEFFREY R KENNEDY DDS PA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Kennedy Dental Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780607812
- **Authorized official:** DR. JEFFREY R KENNEDY DDS (PRESIDENT OWNER)
- **Authorized official phone:** (919) 967-9291

## Contact information

- **Practice address:** 123 FRANKLIN STREET, SUITE 201, CHAPEL HILL, NC 27516
- **Practice address phone:** (919) 967-9291
- **Practice address fax:** (919) 942-4446
- **Mailing address:** 123 FRANKLIN STREET, SUITE 201, CHAPEL HILL, NC 27516
- **Mailing address phone:** (919) 967-9291
- **Mailing address fax:** (919) 942-4446

## Taxonomy

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

## Other

- **Enumeration date:** 07/26/2006
- **Last updated:** 03/07/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0137N | BCBS | — |
| 05 | — | 89902KF | — | NC |