Kevin Chambliss Kennedy Jr., DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

9411 Issued in TN

Practice address

590 Fire Station Rd Ste C
Clarksville, TN 37043-4016

Phone

(931) 648-9930

NPI assigned

Jun 14, 2010

Last updated

Jan 22, 2019By the provider in NPPES

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Clarksville Dental Group PLLC

  dba Clarksville Dental Center

  • Dentist
  • Clarksville, TN
  • NPI 1518758408
  NPD Authorized official
• Clarksville Tongue Tie Center PLLC

  • Pediatric Dentistry
  • Clarksville, TN
  • NPI 1811568561
  NPD Authorized official
• Spring Creek Pediatric Dentistry PLLC

  • Dental Clinic/Center
  • Clarksville, TN
  • NPI 1255816104
  NPD Authorized official

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

{
    "created_epoch": "1276473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548115200000",
    "number": "1629399647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2858 SUMMER LAWN DR",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370434030",
            "telephone_number": "931-648-9930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "590 FIRE STATION RD STE C",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370434016",
            "telephone_number": "931-648-9930"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2028 W Poplar Ave",
            "address_2": "Ste 110",
            "address_purpose": "LOCATION",
            "city": "Collierville",
            "state": "TN",
            "postal_code": "380170618",
            "country_code": "US",
            "telephone_number": "901-861-9668",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "KEVIN",
        "middle_name": "CHAMBLISS",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-14",
        "last_updated": "2019-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TN",
            "license": "9411",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1527793",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gary Kelly, BC-HIS
• Kenneth Kelly, BC-HIS
• Matthew Kelly, BC-HIS
• Sydney Kelso, RBT
• Jessie L. Kennedy
• Victoria Kennedy
• Wikema I Kennedy, RN
• Stephen Warren Kent, M.D.
• Shawna Marie Kersh
• Adam Brook Kessler, PHARMD

• Pediatric Dentistry in Clarksville, TN
• Providers in Clarksville, TN by specialty
• Pediatric Dentistry in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2019; 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.