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Deactivated NPI 1629257357 Deactivated / Inactive NPI Male Practitioner

Dr. Mark H Kennedy , DDS

Dentist • Jackson, MS

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Mark Kennedy has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date October 30, 2007
NPI Deactivation Date November 21, 2024
Total Practice Duration ~17 Years of Practice (2007 – 2024)

Professional Overview & Biography Verified Profile Summary

Dr. Mark Kennedy, DDS was a registered Dentist practicing in Jackson, MS. Throughout an active medical career spanning 17 years, Dr. Kennedy provided care at the practice location at 5800 RIDGEWOOD RD until profile deactivation on 2024-11-21.

Practice Location & Contact Primary Location

Practice Address

5800 Ridgewood Rd
Suite 104

Jackson, MS 392112667

Telephone 6019779330
Fax 6019779887
Associated Practice Facility / Clinic
🏢 John P. Buchanan, Dmd, Pa Facility NPI 1336251669

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist in Jackson, MS

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 18.0 Yrs
Regional Practice Density
82 Specialists

Practicing in Jackson, MS (563 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Dentist Primary Specialty

NUCC Taxonomy Code: 122300000X

State License MS 1693-75

A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

4 Associated Practitioners
Daniel Story

Dentist - General Practice

NPI 1568577039
Dr. Eugene Brown , DDS, MS, PA

Dentist - Orthodontics and Dentofacial Orthopedics

NPI 1780755165

Doctor of Dental Surgery, Master of Science, Physician Assistant

NPI 1811009145

Doctor of Dental Medicine

Dr. Deidra Snell , DMD

Dentist - General Practice

NPI 1811150766

Doctor of Dental Medicine

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated November 21, 2024

Record deactivated on November 21, 2024

NPI Profile Active October 30, 2007

NPI status registered as active in NPPES database

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Updated Practice Location October 30, 2007

Registered at 5800 RIDGEWOOD RD, SUITE 104, JACKSON, MS 392112667 (Tel: 6019779330)

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Updated Business Mailing Address October 30, 2007

Registered at 5800 RIDGEWOOD RD, SUITE 104, JACKSON, MS 392112667 (Tel: 6019779330)

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Provider Name / Credentials Updated October 30, 2007

Recorded as MARK KENNEDY, D.D.S.

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Medical Taxonomy / Specialty Registered (Primary Specialty) October 30, 2007

Dentist (License #1693-75 in MS)

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Initial NPI Registration & Enumeration October 30, 2007

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1629257357
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: October 30, 2007
Last Update: October 30, 2007
Deactivation Date: November 21, 2024

Mailing Address

5800 Ridgewood Rd, Suite 104

Jackson, MS 392112667

Phone: 6019779330

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.