Active NPI
Steven Wayne Kennedy, DMD
- General Practice Dentistry
- Waco, TX
National Provider Identifier
1518488808
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 33765
- Practice address
- 4000 Bellmead Dr
Waco, TX 76705-3138 - Phone
- (254) 799-5461
- NPI assigned
- Jun 28, 2017
- Last updated
- Jul 21, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D10667 | OR | |
| General Practice Dentistry | 1223G0001X | 33765 | TX | Primary |
Addresses
Primary practice location
4000 Bellmead Dr
Waco, TX 76705-3138
Mailing address
5306 Chaparral Dr
Waco, TX 76710-1230
Phone (907) 460-1525
Other practice location 1
2088 NE Williamson Ct
Bend, OR 97701-3760
Phone (541) 382-3691
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 |
|---|---|---|---|
| D10667 | OR | MD | Dentist |
| 33765 | TX | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Acre Wood Dental | Dentist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Public Health Dentistry
- Waco, TX
- NPI 1912380650
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1498608000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1518488808",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5306 CHAPARRAL DR",
"city": "WACO",
"state": "TX",
"postal_code": "767101230",
"telephone_number": "907-460-1525"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4000 BELLMEAD DR",
"city": "WACO",
"state": "TX",
"postal_code": "767053138",
"telephone_number": "254-799-5461"
}
],
"practiceLocations": [
{
"address_1": "2088 NE Williamson Ct",
"address_purpose": "LOCATION",
"city": "Bend",
"state": "OR",
"postal_code": "977013760",
"country_code": "US",
"telephone_number": "541-382-3691",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KENNEDY",
"first_name": "STEVEN",
"middle_name": "WAYNE",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-06-28",
"last_updated": "2022-07-21",
"certification_date": "2021-01-05",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OR",
"license": "D10667",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "33765",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waco, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.