DR. KEVIN CHAMBLISS KENNEDY JR. (NPI# 1629399647) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629399647 |
| Entity Type | Individual |
| Full Name | DR. KEVIN CHAMBLISS KENNEDY JR. |
| Credential | DDS |
| Practice Address |
590 Fire Station Rd Ste C Clarksville TN 37043-4016 |
| Mailing Address |
2858 Summer Lawn Dr Clarksville TN 37043-4030 |
| Practice Telephone | 9316489930 |
| Mailing Telephone | 9316489930 |
| Enumeration Date | 2010-06-14 |
| Last Update Date | 2019-01-22 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
9411 | TN | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | 1527793 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2028 W Poplar Ave, Ste 110, Collierville, TN 380170618 | 9018619668 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922268788 | Kevin P Kennedy | Specialist | 1100 Garden Hwy., Ste. 900, Yuba City, CA 95991-7598 | 2008-06-13 |
| 1730201310 | Kevin Michael Kennedy | Dentist | 3193 Main St, Bridgeport, CT 06606-4225 | 2007-04-04 |
| 1538245303 | Kevin Mark Kennedy | Dentist | 223 Wisconsin Ave, Waukesha, WI 53186-4926 | 2006-10-27 |
| 1679102263 | Kevin Christopher Kennedy | Student in an Organized Health Care Education/Training Program | 725 North St, Pittsfield, MA 01201-4109 | 2020-04-06 |
| 1548896400 | Kevin Patrick Kennedy | Student in an Organized Health Care Education/Training Program | 757 Westwood Plz, Psychiatry, Los Angeles, CA 90095-7419 | 2020-03-22 |
| 1215322342 | Kevin David Kennedy | Family Medicine | 201 16th Ave E, Seattle, WA 98112-5226 | 2015-04-06 |
| 1851569081 | Kevin Thomas Kennedy | Physician Assistant | 15 Abbey Creek Ct, Care of Usa Medical Services, P.C., East Islip, NY 11730-2223 | 2008-02-11 |
| 1841492568 | Kevin D Kennedy | Physical Therapist | 1200 N State St, Suite 500, Jackson, MS 39202-2000 | 2007-06-04 |
| 1831225838 | Kevin Meers Kennedy | Anesthesiology | 1515 6th Ave S, Cooper Green Hospital, Birmingham, AL 35233-1601 | 2007-02-26 |
| 1649298134 | Kevin S Kennedy | Otolaryngology | 1818 So Union Ave, #2-c, Tacoma, WA 98405-1953 | 2006-07-17 |
| Street Address |
590 FIRE STATION RD STE C |
| City | CLARKSVILLE |
| State | TN |
| Zip Code | 37043-4016 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255816104 | Spring Creek Pediatric Dentistry Pllc | Clinic/Center | 590 Fire Station Rd Ste C, Clarksville, TN 37043-4016 | 2018-09-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952958464 | Barbara Gallahan | Technician | 3992 Lakewood Dr., Clarksville, TN 37043 | 2019-08-20 |
| 1144874728 | Intricate Care | Registered Nurse | 2299 Raleigh Ct, Clarksville, TN 37043 | 2019-07-31 |
| 1740842145 | Caila Anne Wiblitzhouser Holm | Counselor | 755 Weatherly Drive, Clarksville, TN 37043 | 2019-07-05 |
| 1407416407 | Heartland Dental Care of Tennessee, PC | Dentist | 930 Highway 76, Clarksville, TN 37043 | 2019-06-20 |
| 1376021501 | Stephen Lawrence Rego | Case Manager/Care Coordinator | Cohen Military Family Clinic, 775 Weatherly Dr, Clarksville, TN 37043 | 2018-07-31 |
| 1366928095 | Kendra Lee | Social Worker | 775 Weatherly Dr., Clarksville, TN 37043 | 2018-07-16 |
| 1245742931 | Andrea L Edelstein | Dentist | 1818 Memorial Dr., Unit 47, Clarksville, TN 37043 | 2017-11-02 |
| 1043736119 | Megan Pritchett Landre | Behavior Technician | 990 South Ridge Trail, Clarksville, TN 37043 | 2017-08-20 |
| 1932624798 | Sandra Melissa Corral | Behavior Technician | 139e Old Trenton Rd, Suite B, Clarksville, TN 37043 | 2017-08-13 |
| 1700306032 | Sahiti Kandati | Dentist | 1777 Madison Ste Ste 100, Clarksville, TN 37043 | 2017-06-27 |
| Find all providers in zip 37043 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568692242 | Andrew Joseph Vaughn | Dentist | 495 Dunlop Ln Ste 112, Clarksville, TN 37040-5296 | 2009-07-16 |
| 1922122324 | Joseph A Fleck Dds Psc | Dentist | 412 Hale Road, Clarksville, IN 47129-1422 | 2007-03-19 |
| 1962560631 | Crystal Gilreath Rucker | Dentist | 2622 Madison St Ste G, Clarksville, TN 37043-6555 | 2006-12-05 |
| 1629173513 | Joseph A Fleck | Dentist | 412 Hale Rd, Clarksville, IN 47129-1422 | 2006-09-14 |
| 1528082682 | Karyl Jean Beauchamp | Dentist | 2297 Rudolphtown Rd, Clarksville, TN 37043 | 2006-07-26 |
| 1942292370 | David R Cheatham | Dentist | 1754 Madison St, Suite 4, Clarksville, TN 37043-2923 | 2005-08-22 |
| 1912999772 | Robert Michael Weaver | Dentist | 271 Stonecrossing Dr, Clarksville, TN 37042-8404 | 2005-08-18 |
| 1265424022 | Lary W. Deeds | Dentist | 271 Stonecrossing Dr Ste B, Clarksville, TN 37042-8404 | 2005-08-18 |
| 1538679097 | Sango Smiles Pediatric Dentistry | Dentist | 2622 Madison St Ste G, Clarksville, TN 37043-6555 | 2017-10-10 |
| 1972919868 | Latasha Michelle Garrett | Dentist | 495 Dunlop Ln Ste 112, Clarksville, TN 37040 | 2014-07-11 |
| Find all providers in CLARKSVILLE | ||||
| City | CLARKSVILLE |
| Zip Code | 37043 |
Please comment or provide details below to improve the information on DR. KEVIN CHAMBLISS KENNEDY JR..
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.