Individual provider Active NPI

James Henry Kennedy, DDS

  • Dentist
  • Eaton, CO
National Provider Identifier
1790767788
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
8230 Issued in CO
Practice address
100 S Cherry Ave
Unit 2 Suite a
Eaton, CO 80615-8253
Phone
(970) 454-3341
Fax
(970) 454-3393
NPI assigned
Nov 16, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 8230 CO Primary

Addresses

Primary practice location

100 S Cherry Ave
Unit 2 Suite a
Eaton, CO 80615-8253

Mailing address

100 S Cherry Ave
Unit 2 Suite a
Eaton, CO 80615-8253
Phone (970) 454-3341

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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

Enrollment IDStateProvider typePAC IDDetails
I20160421000626 CO Order and Referring Only - DentistPractitioner - Dentist 9739487992

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8230COMDPhysical Therapist

NPI Registry JSON

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

{
    "created_epoch": "1132099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1790767788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 S CHERRY AVE",
            "address_2": "UNIT 2 SUITE A",
            "city": "EATON",
            "state": "CO",
            "postal_code": "806158253",
            "telephone_number": "970-454-3341",
            "fax_number": "970-454-3393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 S CHERRY AVE",
            "address_2": "UNIT 2 SUITE A",
            "city": "EATON",
            "state": "CO",
            "postal_code": "806158253",
            "telephone_number": "970-454-3341",
            "fax_number": "970-454-3393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "JAMES",
        "middle_name": "HENRY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-16",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CO",
            "license": "8230",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eaton, CO

Sources for this page

Verify at the official NPI Registry.