Provider Demographics
NPI:1851019459
Name:KENISTON, LYNN (DMD)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:KENISTON
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 1:4364 NEWBERRY ST
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-3435
Mailing Address - Country:US
Mailing Address - Phone:469-358-8525
Mailing Address - Fax:
Practice Address - Street 1:4364 NEWBERRY ST
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-3435
Practice Address - Country:US
Practice Address - Phone:469-358-8525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-19
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38737122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist