Individual
DR. KEITH D KENNEDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
7400 S POWER RD STE 128, GILBERT, AZ 85297-9283
(480) 225-9769
Mailing address
7400 S POWER RD STE 128, GILBERT, AZ 85297-9283
(480) 225-9769
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D5671
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1689938
UNITED CONCORDIA
AZ
01
—
201797682
TAX ID #
AZ
01
—
895401
AHCCCS
AZ
01
—
AZ0413330
BLUE CROSS BLUE SHIELD
AZ
Enumeration date
12/08/2006
Last updated
10/05/2023
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