Provider Demographics
NPI:1891907606
Name:JOHN B. KENISON, DDS, PA
Entity Type:Organization
Organization Name:JOHN B. KENISON, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:KENISON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:603-673-1233
Mailing Address - Street 1:99 AMHERST ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03055-4017
Mailing Address - Country:US
Mailing Address - Phone:603-673-1233
Mailing Address - Fax:
Practice Address - Street 1:99 AMHERST ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:NH
Practice Address - Zip Code:03055-4017
Practice Address - Country:US
Practice Address - Phone:603-673-1233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH89191361Medicaid