Individual provider Active NPI

Paul A Kennedy Jr, DDS

  • Pediatric Dentistry
  • Corpus Christi, TX
National Provider Identifier
1295767903
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
8445 Issued in TX
Practice address
6200 Saratoga Blvd BLDG 1
Corpus Christi, TX 78414-3421
Phone
(361) 992-9500
Fax
(361) 992-1862
NPI assigned
Jul 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X 8445 TX Primary

Addresses

Primary practice location

6200 Saratoga Blvd BLDG 1
Corpus Christi, TX 78414-3421

Mailing address

6200 Saratoga Blvd BLDG 1
Corpus Christi, TX 78414-3421
Phone (361) 992-9500

Other names 1

  • Paul A Kennedy Jr Inc Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
8445TXMDPediatric Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
Paul a Kennedy, Jr., D.D.S., Inc Pediatric Dentistry Past Accepting new patients
KDC Staples, PLLC Pediatric Dentistry PastSince Mar 7, 2021 Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1295767903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6200 SARATOGA BLVD BLDG 1",
            "city": "CORPUS CHRISTI",
            "state": "TX",
            "postal_code": "784143421",
            "telephone_number": "361-992-9500",
            "fax_number": "361-992-1862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6200 SARATOGA BLVD BLDG 1",
            "city": "CORPUS CHRISTI",
            "state": "TX",
            "postal_code": "784143421",
            "telephone_number": "361-992-9500",
            "fax_number": "361-992-1862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY JR",
        "first_name": "PAUL",
        "middle_name": "A",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-06",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TX",
            "license": "8445",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PAUL",
            "last_name": "KENNEDY JR INC",
            "middle_name": "A",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Corpus Christi, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.