Provider Demographics
NPI:1073177531
Name:KENDALL DDS PLLC
Entity Type:Organization
Organization Name:KENDALL DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:KENDALL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:903-597-2201
Mailing Address - Street 1:2124 S DONNYBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-4239
Mailing Address - Country:US
Mailing Address - Phone:903-597-2201
Mailing Address - Fax:903-597-2282
Practice Address - Street 1:2124 S DONNYBROOK AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-4239
Practice Address - Country:US
Practice Address - Phone:903-597-2201
Practice Address - Fax:903-597-2282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty