Scott Kennedy, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

33258 Issued in TX

Practice address

302 S Avenue Q
Clifton, TX 76634-1825

Phone

(254) 675-3518

NPI assigned

Feb 15, 2017

Sex

Male

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 TX

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.

• Ko Dental Group, PC

  • Dentist
  • Clifton, TX
  • NPI 1053911396
  NPD
• Hamilton Dentistry, PC

  • Dentist
  • Hamilton, TX
  • NPI 1417696808
  NPD (past)

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

{
    "created_epoch": "1487116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659916800000",
    "number": "1780123356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 S AVENUE Q",
            "city": "CLIFTON",
            "state": "TX",
            "postal_code": "766341825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 S AVENUE Q",
            "city": "CLIFTON",
            "state": "TX",
            "postal_code": "766341825",
            "telephone_number": "254-675-3518"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "609 Elm Avenue",
            "address_purpose": "LOCATION",
            "city": "Waco",
            "state": "TX",
            "postal_code": "76704",
            "country_code": "US",
            "telephone_number": "254-754-0001",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "310 E Main St",
            "address_purpose": "LOCATION",
            "city": "Hamilton",
            "state": "TX",
            "postal_code": "765311922",
            "country_code": "US",
            "telephone_number": "254-386-8957",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "121 N Rice St",
            "address_purpose": "LOCATION",
            "city": "Hamilton",
            "state": "TX",
            "postal_code": "765311857",
            "country_code": "US",
            "telephone_number": "254-386-8957",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-02-15",
        "last_updated": "2022-08-08",
        "certification_date": "2022-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "33258",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer R Harris-Manier, PTA
• Raygenna Heath
• Waylon Henderson, PTA
• Jennifer E Hudson, FNP-C
• Meredith Addison Humphreys
• Ko Dental Group, PC
• Amanda Marie Lella, RN
• Lily Lingo Therapy, PLLC
• Cathleen Lochte, MS
• Kenneth W Lowrance, MS, RN, CS, FNP-C

• General Practice Dentistry in Clifton, TX
• Providers in Clifton, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2022; 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.