Provider Demographics
NPI:1447373071
Name:KENNEDY, JAMES EDWARD (DMD MS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:EDWARD
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:DMD MS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:455 GOLF BROOK LN APT 103
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-6104
Mailing Address - Country:US
Mailing Address - Phone:407-833-8522
Mailing Address - Fax:407-833-8523
Practice Address - Street 1:910 WILLISTON PARK PT STE 1050
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2107
Practice Address - Country:US
Practice Address - Phone:407-833-8522
Practice Address - Fax:407-833-8523
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLDN152591223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics