Active NPI
Bobby Carl Kennedy, D.D.S
- General Practice Dentistry
- Sacramento, CA
National Provider Identifier
1699804492
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 35625
- Practice address
- 1611 Executive CT Ste 200
Sacramento, CA 95864-2648 - Phone
- (916) 487-5160
- Fax
- (916) 487-8332
- NPI assigned
- Mar 5, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 35625 | CA | Primary |
Addresses
Primary practice location
1611 Executive CT Ste 200
Sacramento, CA 95864-2648
Mailing address
1611 Executive CT Ste 200
Sacramento, CA 95864-2648
Phone (916) 487-5160
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| B3562501 | Medicaid | CA |
Other names 1
- Dr. Bobby Carl Kennedy
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 |
|---|---|---|---|
| 35625 | CA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kennedy Family Dentistry, Inc | 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 and National Provider Directory roles.
-
- Health Maintenance Organization
- Sacramento, CA
- NPI 1407049612
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173052800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1213833600000",
"number": "1699804492",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1611 EXECUTIVE CT STE 200",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958642648",
"telephone_number": "916-487-5160",
"fax_number": "916-487-8332"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1611 EXECUTIVE CT STE 200",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958642648",
"telephone_number": "916-487-5160",
"fax_number": "916-487-8332"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEDY",
"first_name": "BOBBY",
"middle_name": "CARL",
"name_prefix": "Dr.",
"credential": "D.D.S",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-05",
"last_updated": "2008-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "35625",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "B3562501",
"state": "CA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "BOBBY",
"last_name": "KENNEDY",
"middle_name": "CARL",
"prefix": "DR.",
"credential": "D.D.S.",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Sacramento, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.