Individual
NICHOLAS L KENNEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS PC
Contact information
Practice address
110 S 59TH ST, SPRINGFIELD, OR 97478-6975
(541) 747-8030
Mailing address
110 S 59TH ST, SPRINGFIELD, OR 97478-6975
(541) 747-8030
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D5585
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05888-3
—
OR
Enumeration date
09/16/2006
Last updated
07/09/2007
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