Provider Demographics
NPI:1497808042
Name:FENESY, KIM ELIZABETH (DMD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:ELIZABETH
Last Name:FENESY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-1344
Mailing Address - Country:US
Mailing Address - Phone:973-278-1032
Mailing Address - Fax:973-278-3225
Practice Address - Street 1:347 VALLEY RD
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-1344
Practice Address - Country:US
Practice Address - Phone:973-278-1032
Practice Address - Fax:973-278-3225
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI015623001223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics