Provider Demographics
NPI:1508287749
Name:KENNAUGH, CHRIS WESLEY (DDS)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:WESLEY
Last Name:KENNAUGH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3549 39TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-4331
Mailing Address - Country:US
Mailing Address - Phone:409-982-2271
Mailing Address - Fax:409-982-3454
Practice Address - Street 1:3549 39TH ST
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-4331
Practice Address - Country:US
Practice Address - Phone:409-982-2271
Practice Address - Fax:409-982-3454
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-13
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10715122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist