MEDICARE: DR. JOSEPH WILLIAM KENNY DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	01916882	IL

General Provider Information

NPI Number	:	1013930882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH WILLIAM KENNY DDS

Provider Business Mailing Address
First Line	:	526 DIXIE HWY
Second Line	:
City	:	BEECHER
State	:	IL
Zip	:	60401-3698
Country	:	US
Telephone Number	:	708-946-9494
Fax Number	:

Provider Business Practice Location Address
First Line	:	526 DIXIE HWY
Second Line	:
City	:	BEECHER
State	:	IL
Zip	:	60401-3698
Country	:	US
Telephone Number	:	708-946-9494
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	09/24/2009

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