Provider Demographics
NPI:1740399864
Name:DENNIS, KENRICK J (DPM)
Entity Type:Individual
Prefix:
First Name:KENRICK
Middle Name:J
Last Name:DENNIS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11900 FM 1960 RD W
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-3838
Mailing Address - Country:US
Mailing Address - Phone:281-469-2676
Mailing Address - Fax:281-469-0128
Practice Address - Street 1:11900 FM 1960 RD W
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-3838
Practice Address - Country:US
Practice Address - Phone:281-469-2676
Practice Address - Fax:281-469-0128
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX886213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092788102Medicaid
TXT12992Medicare UPIN
OOG33YMedicare ID - Type Unspecified