Provider Demographics
NPI:1891799276
Name:KENNEY, DAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:
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 1:3009 MAHAN CT
Mailing Address - Street 2:COURT
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-5722
Mailing Address - Country:US
Mailing Address - Phone:972-816-0062
Mailing Address - Fax:
Practice Address - Street 1:3009 MAHAN CT
Practice Address - Street 2:COURT
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-5722
Practice Address - Country:US
Practice Address - Phone:972-816-0062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14202122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist