Mitchell Shaw Kennedy

Primary specialty

DentistTaxonomy code 122300000X

License

6001611-15 Issued in WI

Practice address

1336 Creston Park Dr
Janesville, WI 53545-1119

Phone

(608) 755-1082

NPI assigned

Jun 26, 2024

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Agard & Lipker Dental, S.C.

  • General Practice Dentistry
  • Janesville, WI
  • NPI 1710010707
  NPD (past)

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

{
    "created_epoch": "1719360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724457600000",
    "number": "1124863873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1336 CRESTON PARK DR",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535451119",
            "telephone_number": "608-755-1082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1336 CRESTON PARK DR",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535451119",
            "telephone_number": "608-755-1082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "MITCHELL",
        "middle_name": "SHAW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-06-26",
        "last_updated": "2024-08-24",
        "certification_date": "2024-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "6001611-15",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Morgan Keeser
• Franz A. Keilhauer, MD
• Karla Keller, OT
• Kathryn M. Keller, PHD
• Mary Catherine Kellner, RN
• Patricia Sue Kernien, RPH
• Katherine D. Ketterhagen, PA-C
• Hafiz Dewan Hamza Khalid
• Sobia Khalil, MD
• Mahyan Khalili, PHARMD

• Dentist in Janesville, WI
• Providers in Janesville, WI by specialty
• Dentist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 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.