MEDICARE: DUSTIN DONALD 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	122300000X	Dentist	4840	AR

General Provider Information

NPI Number	:	1225820632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DUSTIN DONALD KENNY DDS

Provider Business Mailing Address
First Line	:	805 S 3RD ST
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72756-4620
Country	:	US
Telephone Number	:	479-640-3308
Fax Number	:

Provider Business Practice Location Address
First Line	:	7801 PHOENIX AVE
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-5091
Country	:	US
Telephone Number	:	479-306-6156
Fax Number	:

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

Provider Enumeration Date	:	05/21/2025
Last Update Date	:	05/21/2025

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