Justine Sara Kennedy

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

11066 Issued in SC

Practice address

340 Harrison Bridge Rd Ste D
Simpsonville, SC 29680-7133

Phone

(864) 962-3515

NPI assigned

Aug 23, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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.

• Small Smiles of Cincinnati, LLC

  • General Practice Dentistry
  • Cincinnati, OH
  • NPI 1326097569
  NPD (past)

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

{
    "created_epoch": "1187827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754006400000",
    "number": "1487847240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 N GRAND AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810033111",
            "telephone_number": "719-562-4461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 HARRISON BRIDGE RD STE D",
            "city": "SIMPSONVILLE",
            "state": "SC",
            "postal_code": "296807133",
            "telephone_number": "864-962-3515"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4403 Urbana Dr Apt 304",
            "address_purpose": "LOCATION",
            "city": "Orlando",
            "state": "FL",
            "postal_code": "328373609",
            "country_code": "US",
            "telephone_number": "321-948-9066",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "JUSTINE",
        "middle_name": "SARA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-23",
        "last_updated": "2025-08-01",
        "certification_date": "2025-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30-022644",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "11066",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lori Ann Kantor, COTA/L
• Samyukta Kappagantula, DPT
• Sheila A Keasler, CRNA
• Burchel Lyman Keller, LISW-CP
• Justin M Kellett, PHARMD
• Kidbuilders LLC
• Kids Onn the Go Inc
• Kim L. Capehart, D.D.S., P.a.
• Karisa Kay Kindy, PA-C
• Kendall Kineard

• General Practice Dentistry in Simpsonville, SC
• Providers in Simpsonville, SC by specialty
• General Practice Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2025; 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.