NPIMap

Organization Active NPI

Kennedy Dental LLC

  • General Practice Dentistry
  • Portland, OR
National Provider Identifier
1003065251
Registry record updated Oct 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D6716 Issued in OR
Legal business name
KENNEDY DENTAL LLC
Practice address
3506 N Lombard St
Portland, OR 97217-5902
Phone
(503) 289-0230
Fax
(503) 286-5055
NPI assigned
Sep 11, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Gerald KennedyNPI 1295725406
Title
Owner/Dentist
Phone
(503) 289-0230

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X D6716 OR Primary

Addresses

Primary practice location

3506 N Lombard St
Portland, OR 97217-5902

Mailing address

3506 N Lombard St
Portland, OR 97217-5902
Phone (503) 289-0230

National Provider Directory

National Provider Directory

Locations

3506 N Lombard St
Portland, OR 97217
Phone (503) 289-0230

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1221091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730246400000",
    "number": "1003065251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3506 N LOMBARD ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972175902",
            "telephone_number": "503-289-0230",
            "fax_number": "503-286-5055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3506 N LOMBARD ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972175902",
            "telephone_number": "503-289-0230",
            "fax_number": "503-286-5055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNEDY DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-11",
        "last_updated": "2024-10-30",
        "certification_date": "2024-10-30",
        "status": "A",
        "authorized_official_last_name": "KENNEDY",
        "authorized_official_first_name": "GERALD",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "503-289-0230"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D6716",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.