Provider Demographics
NPI:1649251869
Name:KENIEN, EDWARD ROBERT (DDS)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ROBERT
Last Name:KENIEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:EDWARD
Other - Middle Name:ROBERT
Other - Last Name:KENIEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS INC
Mailing Address - Street 1:PO BOX 4477
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91617-0477
Mailing Address - Country:US
Mailing Address - Phone:661-834-4334
Mailing Address - Fax:661-834-5885
Practice Address - Street 1:3723 WILSON RD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-5141
Practice Address - Country:US
Practice Address - Phone:661-834-4334
Practice Address - Fax:661-834-5885
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27157122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist