Provider Demographics
NPI:1548372253
Name:KENESON, JOE R (DDS)
Entity type:Individual
Prefix:DR
First Name:JOE
Middle Name:R
Last Name:KENESON
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 1:1164 HWY 327 E
Mailing Address - Street 2:
Mailing Address - City:SILSBEE
Mailing Address - State:TX
Mailing Address - Zip Code:77656
Mailing Address - Country:US
Mailing Address - Phone:409-385-3651
Mailing Address - Fax:409-385-9456
Practice Address - Street 1:1164 HWY 327 E
Practice Address - Street 2:
Practice Address - City:SILSBEE
Practice Address - State:TX
Practice Address - Zip Code:77656
Practice Address - Country:US
Practice Address - Phone:409-385-3651
Practice Address - Fax:409-385-9456
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13471122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD13471OtherBLUE CROSS
TX875927OtherUNITED CONCORDIA
TX0909418-01Medicaid