Provider Demographics
NPI:1992917868
Name:KENISON, JOHN B (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:B
Last Name:KENISON
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 1:99 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:603-673-8116
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:603-673-8116
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH10041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH89191361Medicaid