Provider Demographics
NPI:1609016229
Name:KENNEY, CHARLES MICHAEL (DDS)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:MICHAEL
Last Name:KENNEY
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 1:3328 GATWICK PL
Mailing Address - Street 2:
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75234-2248
Mailing Address - Country:US
Mailing Address - Phone:214-478-0701
Mailing Address - Fax:
Practice Address - Street 1:17721 DALLAS PKWY STE 116
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-7338
Practice Address - Country:US
Practice Address - Phone:469-685-1700
Practice Address - Fax:888-491-6582
Is Sole Proprietor?:No
Enumeration Date:2009-02-22
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX139881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice