Organization
JENNIFER A KENNEDY DDS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JENNIFER A KENNEDY DDS (DENTIST)
(217) 235-0556
Entity
Organization
Contact information
Practice address
601 BROADWAY AVE, MATTOON, IL 61938-4340
(217) 235-0556
(217) 234-7243
Mailing address
601 BROADWAY AVE, MATTOON, IL 61938-4340
(217) 235-0556
(217) 234-7243
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
019024517
IL
Other
Enumeration date
12/11/2013
Last updated
12/11/2013
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