Active NPI
Monica Ann Kennard, D.D.S.
- Pediatric Dentistry
- Portland, OR
National Provider Identifier
1316953268
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- D9203
- Practice address
- 2824 NE Wasco St
Portland, OR 97232-1772 - Phone
- (503) 284-5678
- Fax
- (503) 284-5556
- NPI assigned
- Jul 31, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | D9203 | OR | Primary |
Addresses
Primary practice location
2824 NE Wasco St
Portland, OR 97232-1772
Mailing address
4449 SW Twombly Ave
Portland, OR 97239-1372
Phone (503) 894-8065
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
| License | State | Type | Specialty |
|---|---|---|---|
| D9203 | OR | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154304000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1300752000000",
"number": "1316953268",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4449 SW TWOMBLY AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972391372",
"telephone_number": "503-894-8065"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2824 NE WASCO ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972321772",
"telephone_number": "503-284-5678",
"fax_number": "503-284-5556"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNARD",
"first_name": "MONICA",
"middle_name": "ANN",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-07-31",
"last_updated": "2011-03-22",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "OR",
"license": "D9203",
"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 Mar 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.