Provider Demographics
NPI:1346271970
Name:KENYON, LOUIS PETER (DMD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:PETER
Last Name:KENYON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1734
Mailing Address - Street 2:
Mailing Address - City:MATTAPOISETT
Mailing Address - State:MA
Mailing Address - Zip Code:02739-0445
Mailing Address - Country:US
Mailing Address - Phone:508-758-4818
Mailing Address - Fax:508-758-1369
Practice Address - Street 1:28 FAIRHAVEN RD.
Practice Address - Street 2:
Practice Address - City:MATTAPOISETT
Practice Address - State:MA
Practice Address - Zip Code:02739
Practice Address - Country:US
Practice Address - Phone:508-758-4818
Practice Address - Fax:508-758-1369
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA159321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
27816OtherUNITED CONCORDIA
MAX10624OtherBLUE CROSS BLUE SHIELD