Provider Demographics
NPI:1225820632
Name:KENNY, DUSTIN DONALD (DDS)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:DONALD
Last Name:KENNY
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 1:805 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-4620
Mailing Address - Country:US
Mailing Address - Phone:479-640-3308
Mailing Address - Fax:
Practice Address - Street 1:7801 PHOENIX AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5091
Practice Address - Country:US
Practice Address - Phone:479-306-6156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4840122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist