Individual
DR. NICHOLAS RYAN KENNING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.D.
Contact information
Practice address
3950 VETERANS DR STE 100, SAINT CLOUD, MN 56303-3424
(320) 252-3611
(320) 252-7574
Mailing address
3950 VETERANS DR STE 100, SAINT CLOUD, MN 56303-3424
(320) 252-3611
(320) 252-7574
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
64354
MN
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
D13402
MN
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
64354
MN
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
D13402
MN
Other
Enumeration date
07/11/2014
Last updated
06/25/2020
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