# KENEDY DENTAL PLLC

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

## Provider details

- **NPI number:** 1962227371
- **Authorized official:** DR. MAXIM M MOSSMAN DDS (CEO)
- **Authorized official phone:** (972) 838-3772

## Contact information

- **Practice address:** 131 BUSINESS PARK BLVD STE 600, KENEDY, TX 78119-3512
- **Practice address phone:** (972) 838-3772
- **Mailing address:** PO BOX 195487, DALLAS, TX 75219-8608
- **Mailing address phone:** (972) 838-3772

## Taxonomy

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

## Other

- **Enumeration date:** 11/20/2024
- **Last updated:** 11/20/2024