Organization
GREGORY L. KENNEDY D.M.D PC
Active
Other names
Grand Bay Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GREGORY L KENNEDY DMD (DOCTOR / OWNER)
(251) 865-3500
Entity
Organization
Contact information
Practice address
12475 US HIGHWAY 90, GRAND BAY, AL 36541-5796
(251) 865-3500
(251) 865-1101
Mailing address
PO BOX 628, GRAND BAY, AL 36541-0628
(251) 865-3500
(251) 865-1101
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3862
DENTAL LICENSE
AL
Enumeration date
07/14/2022
Last updated
07/14/2022
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