NPIMap

Organization Active NPI

Jetty United PLLC

  • Pediatric Dentistry
  • San Antonio, TX
National Provider Identifier
1225797467
Registry record updated Dec 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
JETTY UNITED PLLC
Practice address
10003 NW Military Hwy Ste 3201
San Antonio, TX 78231-1892
Phone
(210) 417-4181
Fax
(210) 504-4969
NPI assigned
Dec 15, 2021
Last updated
Dec 15, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2021

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

Authorized official

Name
Paul A Kennedy III, DDSNPI 1376568469
Title
Doctor/Owner
Phone
(210) 971-6018

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU
Pediatric Dentistry 1223P0221X NU Primary
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X NU

Addresses

Primary practice location

10003 NW Military Hwy Ste 3201
San Antonio, TX 78231-1892

Mailing address

10003 NW Military Hwy Ste 3201
San Antonio, TX 78231-1892
Phone (210) 971-6018

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://www.paulkennedydds.com/ Paul A Kennedy, Jr., D.D.S., Inc

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1639526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639526400000",
    "number": "1225797467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10003 NW MILITARY HWY STE 3201",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782311892",
            "telephone_number": "210-971-6018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10003 NW MILITARY HWY STE 3201",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782311892",
            "telephone_number": "210-417-4181",
            "fax_number": "210-504-4969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JETTY UNITED PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-15",
        "last_updated": "2021-12-15",
        "certification_date": "2021-12-15",
        "status": "A",
        "authorized_official_last_name": "KENNEDY",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DOCTOR/OWNER",
        "authorized_official_telephone_number": "210-971-6018",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.paulkennedydds.com/",
            "affiliation": "Y",
            "affiliationName": "Paul A Kennedy, Jr., D.D.S., Inc",
            "address_1": "10003 NW Military Hwy Ste 3201",
            "city": "San Antonio",
            "state": "TX",
            "country_code": "US",
            "postal_code": "782311892",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2021; 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.