Provider Demographics
NPI:1093123226
Name:KENDRICK, REBECCA (DDS)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:KENDRICK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 S MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-2342
Mailing Address - Country:US
Mailing Address - Phone:708-699-3967
Mailing Address - Fax:
Practice Address - Street 1:1933 FRANCISCAN WAY
Practice Address - Street 2:
Practice Address - City:WEST CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60185-6201
Practice Address - Country:US
Practice Address - Phone:630-231-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019029836122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist