Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 2740 | MT |
NPI | 1003197302 |
---|---|
Provider Name | Danielle Rain Kennedy |
First Address | Browning, MT 59417-0730 |
Second Address | Browning, MT 59417-0730 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2011 |
Last Update Date | 18/01/2017 |