Paul Alexander Kennedy III, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

20778 Issued in TX

Practice address

6200 Saratoga Blvd
Corpus Christi, TX 78414-3421

Phone

(361) 992-9500

Fax

(361) 992-1862

NPI assigned

Jul 12, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Jetty United PLLC

  • Pediatric Dentistry
  • San Antonio, TX
  • NPI 1225797467
  NPD Authorized official
• KDC Staples, PLLC

  • Pediatric Dentistry
  • Corpus Christi, TX
  • NPI 1659966323
  NPD Authorized official
• Paul a Kennedy, Jr., D.D.S., Inc

  • Pediatric Dentistry
  • Corpus Christi, TX
  • NPI 1720008568
  NPD (past) Authorized official
• The University of Texas Health Science Center at San Antonio

  • General Acute Care Hospital
  • San Antonio, TX
  • NPI 1326829904
  NPD (past)
• University of Texas Health Science Center at San Antonio

  • Dental Clinic/Center
  • San Antonio, TX
  • NPI 1760424873
  NPD (past)

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639526400000",
    "number": "1376568469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6200 SARATOGA BLVD",
            "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",
            "city": "CORPUS CHRISTI",
            "state": "TX",
            "postal_code": "784143421",
            "telephone_number": "361-992-9500",
            "fax_number": "361-992-1862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "PAUL",
        "middle_name": "ALEXANDER",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-12",
        "last_updated": "2021-12-15",
        "certification_date": "2021-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TX",
            "license": "20778",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "159672801",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelly'S Pharmacy
• Kellys Pediatric Pharmacy & Compounding
• Katie Kemp
• Sean Kendrick-Graham
• Paul A Kennedy Jr, DDS
• Winter R Kennedy, LPC
• April Darlene Kenock, LVN
• Paul David Kenyon, M.D.
• David Kerek, DO
• Kerr Technical Services, LLC

• Pediatric Dentistry in Corpus Christi, TX
• Providers in Corpus Christi, TX by specialty
• Pediatric Dentistry in Texas

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.