Ann Douglas Kennedy, D.D.S

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

10082 Issued in NC

Practice address

16607 Riverstone Way Ste 300
Charlotte, NC 28277

Phone

(704) 544-5000

NPI assigned

May 29, 2015

Sex

Female

Sole proprietor

Yes

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

Enrolled in NY

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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 and National Provider Directory roles.

• Brookdale Hospital Medical Center

  • General Acute Care Hospital
  • Brooklyn, NY
  • NPI 1720028772
  Medicare reassignment NPD
• The Brookdale Hospital Medical Center

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Brooklyn, NY
  • NPI 1639756406
  NPD
• Suzanne Bird PLLC

  • General Practice Dentistry
  • Charlotte, NC
  • NPI 1093597551
  NPD (past)

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

{
    "created_epoch": "1432857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543190400000",
    "number": "1700266236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16607 RIVERSTONE WAY STE 300",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282775750",
            "telephone_number": "336-209-2974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16607 RIVERSTONE WAY STE 300",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "28277",
            "telephone_number": "704-544-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "890 Summit Crossing Pl",
            "address_purpose": "LOCATION",
            "city": "Gastonia",
            "state": "NC",
            "postal_code": "280542192",
            "country_code": "US",
            "telephone_number": "704-874-0377",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "890 Summit Crossing Pl",
            "address_purpose": "LOCATION",
            "city": "Gastonia",
            "state": "NC",
            "postal_code": "280542192",
            "country_code": "US",
            "telephone_number": "704-874-0377",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3333 Burnet Ave",
            "address_purpose": "LOCATION",
            "city": "Cincinnati",
            "state": "OH",
            "postal_code": "452293026",
            "country_code": "US",
            "telephone_number": "513-636-4200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "ANN",
        "middle_name": "DOUGLAS",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-05-29",
        "last_updated": "2018-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NC",
            "license": "10082",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NC",
            "license": "10082",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kenitra C. Richardson, DMD, PLLC (Peace Haven Smiles)
• Jennifer Michalec Kennard, MD
• Allison Kennebeck, LMFTA
• Deborah Victoria Kennedy-Ziegler, PH.D.
• Angela Kennedy, MSW
• Beth Ann Kennedy, LPC
• Bonnie M Kennedy, C.R.N.A.
• Carrie Frasure Kennedy, FNP
• Cindy Sutton Kennedy, RPH
• Connor Kennedy, PT, DPT

• Pediatric Dentistry in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Pediatric Dentistry in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.