Individual
DR. KELLY SUE KENNEDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
305 W 12TH AVE, DENTAL FACULTY PRACTICE, COLUMBUS, OH 43210-1267
(614) 292-5574
(614) 292-9472
Mailing address
305 W 12TH AVE, COLUMBUS, OH 43210-1267
(614) 292-5574
(614) 292-9472
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
2322
OH
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
30-022717
OH
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
30.022717
OH
Other
Enumeration date
05/24/2007
Last updated
12/19/2019
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