Provider Demographics
NPI:1457575847
Name:KENNA, WILLIAM BURRIS III (DMD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BURRIS
Last Name:KENNA
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 CARILION LN
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29617-7911
Mailing Address - Country:US
Mailing Address - Phone:864-517-5012
Mailing Address - Fax:
Practice Address - Street 1:1803 WOODRUFF RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-5936
Practice Address - Country:US
Practice Address - Phone:864-297-5268
Practice Address - Fax:864-297-6716
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC42721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice