Healthcare Provider Details

I. General information

NPI: 1477358091
Provider Name (Legal Business Name): KENOL JUNIOR FELIX DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2025
Last Update Date: 07/24/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

469 W BASE ST
MADISON FL
32234
US

IV. Provider business mailing address

2804 REMINGTON GREEN CIR STE 2
TALLAHASSEE FL
32308-1550
US

V. Phone/Fax

Practice location:
  • Phone: 850-973-1402
  • Fax: 850-973-1450
Mailing address:
  • Phone: 850-385-4494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN30760
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: