Healthcare Provider Details

I. General information

NPI: 1144475971
Provider Name (Legal Business Name): JOE KENESON DDS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2008
Last Update Date: 08/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1164 HWY 327 E
SILSBEE TX
77656-4141
US

IV. Provider business mailing address

1164 HWY 327 E
SILSBEE TX
77656-4141
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 Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number13471
License Number StateTX

VIII. Authorized Official

Name: DR. JOE KENESON
Title or Position: PRESIDENT
Credential: DDS
Phone: 409-385-3651