Provider Demographics
NPI:1932496148
Name:KENNER, GIA DENISE (DDS)
Entity Type:Individual
Prefix:
First Name:GIA
Middle Name:DENISE
Last Name:KENNER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 GREENBRIAR ST
Mailing Address - Street 2:APT 507
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-5200
Mailing Address - Country:US
Mailing Address - Phone:310-925-8885
Mailing Address - Fax:
Practice Address - Street 1:4100 GREENBRIAR ST
Practice Address - Street 2:APT 507
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-5200
Practice Address - Country:US
Practice Address - Phone:310-925-8885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX292241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice