Provider Demographics
NPI:1073675443
Name:BREDE, KENDRICK R (DMD)
Entity Type:Individual
Prefix:DR
First Name:KENDRICK
Middle Name:R
Last Name:BREDE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1253 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-2682
Mailing Address - Country:US
Mailing Address - Phone:781-444-1505
Mailing Address - Fax:781-449-3231
Practice Address - Street 1:1253 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-2682
Practice Address - Country:US
Practice Address - Phone:781-444-1505
Practice Address - Fax:781-449-3231
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA147901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice