Keith D Kennedy, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D5671 Issued in AZ

Practice address

7400 S Power Rd Ste 128
Gilbert, AZ 85297-9283

Phone

(480) 225-9769

NPI assigned

Dec 8, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• PRD Partners PLLC

  • General Practice Dentistry
  • Gilbert, AZ
  • NPI 1255111274
  NPD

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

{
    "created_epoch": "1165536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696464000000",
    "number": "1326107004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7400 S POWER RD STE 128",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852979283",
            "telephone_number": "480-225-9769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7400 S POWER RD STE 128",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852979283",
            "telephone_number": "480-225-9769"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3844 E Latham Way",
            "address_purpose": "LOCATION",
            "city": "Gilbert",
            "state": "AZ",
            "postal_code": "852975426",
            "country_code": "US",
            "telephone_number": "480-225-9769",
            "fax_number": "520-868-1200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "KEITH",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-08",
        "last_updated": "2023-10-05",
        "certification_date": "2023-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D5671",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID #",
            "identifier": "201797682",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCCCS",
            "identifier": "895401",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "1689938",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "AZ0413330",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carly Lin Kemp, FNP-BC
• Maria S Kenneally, APNP, BC
• Brian Kennedy, PA-C
• Jacqueline Kennedy
• Julie Allen Kennedy, PAC
• Taylor Kennedy, RD
• Jaclyn Kenney
• Wei Kenney
• Kent Kneip OD PLLC
• Lisa Kenyon, RN, APRN-RNP

• General Practice Dentistry in Gilbert, AZ
• Providers in Gilbert, AZ by specialty
• General Practice Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2023; 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.