Healthcare Provider Details

I. General information

NPI: 1548372253
Provider Name (Legal Business Name): JOE R KENESON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1164 HWY 327 E
SILSBEE TX
77656
US

IV. Provider business mailing address

1164 HWY 327 E
SILSBEE TX
77656
US

V. Phone/Fax

Practice location:
  • Phone: 409-385-3651
  • Fax: 409-385-9456
Mailing address:
  • Phone: 409-385-3651
  • Fax: 409-385-9456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number13471
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: