DR. TOLLY ARCHIE KENNON JR. (NPI# 1871657320) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871657320 |
| Entity Type | Individual |
| Full Name | DR. TOLLY ARCHIE KENNON JR. |
| Other Name | DR. TOLLY A KENNON JR. |
| Credential | D.D.S. |
| Practice Address |
1028 W 5th St Charlotte NC 28202-1207 |
| Practice Telephone | 7043321591 |
| Practice Fax Number | 7043348641 |
| Mailing Telephone | 7043321591 |
| Mailing Fax Number | 7043348641 |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
3686 | NC | Dental Providers |
| Street Address |
1028 W 5TH ST |
| City | CHARLOTTE |
| State | NC |
| Zip Code | 28202-1207 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609418425 | Monarch | Community/Behavioral Health | 215 North Pine Street Unit 705, Charlotte, NC 28202 | 2019-10-14 |
| 1396211892 | Brooke Graham | Behavior Technician | 107 New Edition Court Carey, Raleigh, NC 28202 | 2018-10-23 |
| 1740704352 | Targetcare, Inc. | Health Educator | 831 E. Morehead Street, Suite 900, Charlotte, NC 28202 | 2017-07-26 |
| 1659828291 | Reserve Health, PC | Family Medicine | 135 W 10th St, Charlotte, NC 28202 | 2016-09-01 |
| 1275905887 | Tameka Wade Brewington | Counselor | 615 E 6th St Ste 112, Charlotte, NC 28202 | 2015-10-22 |
| 1962815159 | Teisha Miller | Social Worker | 700 N. Tryon Street, Charlotte, NC 28202 | 2014-06-05 |
| 1699193672 | Elizabeth Ann Peterson-vita | Psychologist | 700 East Stonewall Street, Suite 714, Charlotte, NC 28202 | 2014-04-07 |
| 1942631437 | Avery Sales | Durable Medical Equipment & Medical Supplies | 103 W Morehead St, Charlotte, NC 28202 | 2013-12-09 |
| 1801236484 | Annette Goodman | Counselor | 415 E. Trade Street, Charlotte, NC 28202 | 2013-06-27 |
| 1174960181 | Jennifer D'silva | Dentist | 210 E Trade St # 484, Charlotte, NC 28202 | 2013-05-30 |
| Find all providers in zip 28202 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003296831 | Jesse Eric Ricciuti | Dentist | 10042 Park Cedar Dr Ste B, Charlotte, NC 28210 | 2015-06-07 |
| 1518346105 | Christopher Abernathy | Dentist | 3111 Springbank Ln Ste A, Charlotte, NC 28226 | 2015-05-28 |
| 1619314556 | George Yi Jaan Soung | Dentist | 5700 University Pointe Blvd Ste 104, Charlotte, NC 28262-5026 | 2013-06-02 |
| 1013278696 | Andrew Henry | Dentist | 8840 Blakeney Professional Dr Ste 300, Charlotte, NC 28277-6749 | 2012-05-31 |
| 1861703183 | Carrie A Baldwin | Dentist | 1601 Abbey Pl Ste 220, Charlotte, NC 28209-3825 | 2010-07-01 |
| 1407011927 | Karthik Kanakasundaram Naidu | Dentist | 5700 University Pointe Blvd, Suite 104, Charlotte, NC 28262-5026 | 2008-07-24 |
| 1861650095 | Mid Michigan Oral Surgery | Dentist | 110 N Cochran Ave, Charlotte, MI 48813-1508 | 2008-05-23 |
| 1942474077 | Waheed V Mohamed | Dentist | 411 Billingsley Rd., Suite 105, Charlotte, NC 28211 | 2008-04-18 |
| 1659543155 | John Omalley | Dentist | 2007 Randolph Rd, Charlotte, NC 28207-1233 | 2008-03-25 |
| 1679756597 | Robert L Seymour Dds Pa | Dentist | 2711 Randolph Rd Ste 510, Charlotte, NC 28207-2027 | 2007-12-13 |
| Find all providers in CHARLOTTE | ||||
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| 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.