Roselyn Brooks Kennedy, DMD

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

8365 Issued in NC

Practice address

1400 Walter Reed Rd
Ste 200
Fayetteville, NC 28304-4411

Phone

(910) 864-9884

Fax

(910) 354-1399

NPI assigned

May 16, 2007

Last updated

Feb 26, 2009By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Dr. Roselyn Brooks Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ballance & Derose DDS PA

  • General Practice Dentistry
  • Fayetteville, NC
  • NPI 1386677961
  NPD (past)

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

{
    "created_epoch": "1179273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1235606400000",
    "number": "1922214691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2041 SILAS CREEK PKWY",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271035147",
            "telephone_number": "336-777-0303",
            "fax_number": "336-777-3448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 WALTER REED RD",
            "address_2": "STE 200",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283044411",
            "telephone_number": "910-864-9884",
            "fax_number": "910-354-1399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "ROSELYN",
        "middle_name": "BROOKS",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-16",
        "last_updated": "2009-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "OH",
            "license": "30019228",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NC",
            "license": "8365",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0102838",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ROSELYN",
            "last_name": "BROOKS",
            "prefix": "DR.",
            "credential": "DMD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kendrics Place LLC
• Keneri, LLC (Home Instead Senior Care of Fayetteville)
• Amber D Kennedy, MA
• Danielle Kennedy, BCBA
• Michelle Ann Kennedy, OTD, OTR/L
• Jacqueline McKoy Kenney
• Malinda Marie Kennison, DPT
• Edward M Kenshock, OD
• John N Kent, DMD
• Lella E Kenworthy

• Pediatric Dentistry in Fayetteville, NC
• Providers in Fayetteville, 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 Feb 26, 2009; 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.