Provider Demographics
NPI:1922116565
Name:GADDY, KENAYSHA ESHONJI (DDS)
Entity type:Individual
Prefix:DR
First Name:KENAYSHA
Middle Name:ESHONJI
Last Name:GADDY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5638 NC HIGHWAY 42 W STE 109
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-7998
Mailing Address - Country:US
Mailing Address - Phone:919-772-1463
Mailing Address - Fax:
Practice Address - Street 1:5638 NC HIGHWAY 42 W STE 109
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-7998
Practice Address - Country:US
Practice Address - Phone:919-772-1463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC78501223G0001X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89-045YUMedicaid
9026UOtherBLUE CROSS BLUE SHIELD NC