Gregory Wayne Kennedy, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

039664 Issued in NY

Practice address

164 Commack Rd
Suite 4
Commack, NY 11725-3430

Phone

(631) 499-3377

Fax

(631) 858-0586

NPI assigned

May 24, 2007

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1179964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1902017973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "164 COMMACK RD",
            "address_2": "SUITE 4",
            "city": "COMMACK",
            "state": "NY",
            "postal_code": "117253430",
            "telephone_number": "631-499-3377",
            "fax_number": "631-858-0586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "164 COMMACK RD",
            "address_2": "SUITE 4",
            "city": "COMMACK",
            "state": "NY",
            "postal_code": "117253430",
            "telephone_number": "631-499-3377",
            "fax_number": "631-858-0586"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "GREGORY",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "039664",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura Jean Kelly, RD, CSO, CDN
• Maureen Jeanette Kelly, P.A.
• Stephen Patrick Kelly, COTA
• Andrea Michelle Keltos, LMSW
• Bethany H Kennedy, ANP, MSN, RN
• Regina Kent, OTR/L
• Shannon L Kerekes, MS OTR/L
• Alyssa Danielle Kerr, PA-C
• David Lawrence Kessler, PHD
• Patricia Kettell, M.S.

• General Practice Dentistry in Commack, NY
• Providers in Commack, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.