Individual provider Active NPI

Harold D Kennedy, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Opelousas, LA
National Provider Identifier
1508975574
Registry record updated Sep 13, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
4625 Issued in LA
Practice address
2351 Larkspur Lane
Opelousas, LA 70570
Phone
(337) 948-9878
Fax
(337) 948-9097
NPI assigned
Aug 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X 4625 LA Primary

Addresses

Primary practice location

2351 Larkspur Lane
Opelousas, LA 70570

Mailing address

2351 Larkspur Lane
Opelousas, LA 70570
Phone (337) 948-9878

Other identifiers 1

IdentifierTypeStateIssuer
1846252MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
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.
Opted out of Medicare
Yes, effective Oct 8, 2013 through Oct 8, 2027

Care Compare profile

Medicare Care Compare
Specialty
Oral Surgery
Education
Other, 1992
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

800 Virtue St
Suite 107
Chalmette, LA 70043-1261

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4625LAMDOral and Maxillofacial Surgery (Dentist)

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1284336000000",
    "number": "1508975574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2351 LARKSPUR LANE",
            "city": "OPELOUSAS",
            "state": "LA",
            "postal_code": "70570",
            "telephone_number": "337-948-9878",
            "fax_number": "337-948-9097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2351 LARKSPUR LANE",
            "city": "OPELOUSAS",
            "state": "LA",
            "postal_code": "70570",
            "telephone_number": "337-948-9878",
            "fax_number": "337-948-9097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "HAROLD",
        "middle_name": "D",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2010-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "LA",
            "license": "4625",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1846252",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Opelousas, LA

Sources for this page

Verify at the official NPI Registry.