Provider Demographics
NPI:1881615169
Name:KESNER, MICHAEL LEE (DDS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEE
Last Name:KESNER
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 1:2205 WILLIAMS TRACE BLVD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4514
Mailing Address - Country:US
Mailing Address - Phone:281-265-1111
Mailing Address - Fax:281-491-8483
Practice Address - Street 1:2205 WILLIAMS TRACE BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4514
Practice Address - Country:US
Practice Address - Phone:281-265-1111
Practice Address - Fax:281-491-8483
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX144151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice