Theresa D Kenna, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6807 Issued in KY

Practice address

201 W Main St
Vine Grove, KY 40175-1304

Phone

(270) 877-2011

Fax

(270) 877-2030

NPI assigned

Jun 5, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dr. Theresa K Miller 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 and National Provider Directory roles.

• Main Street Dental, LLC

  • Dental Clinic/Center
  • Vine Grove, KY
  • NPI 1588909642
  NPD (past)

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

{
    "created_epoch": "1181001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1394582400000",
    "number": "1982806592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 W MAIN ST",
            "city": "VINE GROVE",
            "state": "KY",
            "postal_code": "401751304",
            "telephone_number": "270-877-2011",
            "fax_number": "270-877-2030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 W MAIN ST",
            "city": "VINE GROVE",
            "state": "KY",
            "postal_code": "401751304",
            "telephone_number": "270-877-2011",
            "fax_number": "270-877-2030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNA",
        "first_name": "THERESA",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-05",
        "last_updated": "2014-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KY",
            "license": "6807",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "60068079",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "THERESA",
            "last_name": "MILLER",
            "middle_name": "K",
            "prefix": "DR.",
            "credential": "DMD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Inclusive Therapy Services LLC
• J. Mason & Associates
• Karen S. Keene, CCC-SLP
• Amanda Kay Kelly
• Makenzi Alexandra Kelly
• Brenda Doreen King, 01/01/2011
• Tatjana Gabrielle Lauterbach, LCSW
• Jessi Diana Lloyd, NP-C
• Shayna Jane Luttrell, M.S. CCC SLP
• Main Street Dental, LLC

• All providers in Vine Grove, KY
• General Practice Dentistry in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2014; 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.