Healthcare Provider Details

I. General information

NPI: 1508929142
Provider Name (Legal Business Name): WILLIAM EDWARD KENNY JR. D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 AZALEA WAY
TRENTON NJ
08690-1304
US

IV. Provider business mailing address

1 AZALEA WAY
TRENTON NJ
08690-1304
US

V. Phone/Fax

Practice location:
  • Phone: 609-585-6161
  • Fax: 609-588-8723
Mailing address:
  • Phone: 609-585-6161
  • Fax: 609-588-8723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDI10966
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: