Mitchell Shaw Kennedy
Dentist in Janesville, WI. Individual provider (NPI-1).
NPI number1124863873
StatusActive
Last updated in NPPESAug 24, 2024
Details
- NPI
- 1124863873
- Entity type
- Individual (NPI-1)
- Name
- Mitchell Shaw Kennedy
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jun 26, 2024
- Certification date
- Aug 24, 2024
- Last updated
- Aug 24, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | 6001611-15 | WI | Yes |
Practice location
1336 Creston Park DrJanesville, WI 53545-1119
Phone 608-755-1082
Mailing address
1336 Creston Park DrJanesville, WI 53545-1119
Phone 608-755-1082
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All 44 Dentist providers in Janesville · All 1,806 providers in Janesville
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