Provider Demographics
NPI:1114137700
Name:KENDALL ORAL SURGERY
Entity Type:Organization
Organization Name:KENDALL ORAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:A
Authorized Official - Last Name:PAREDES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:305-595-4122
Mailing Address - Street 1:8700 N KENDALL DR
Mailing Address - Street 2:SUITE 221
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2206
Mailing Address - Country:US
Mailing Address - Phone:305-595-4122
Mailing Address - Fax:305-595-5908
Practice Address - Street 1:8700 N KENDALL DR
Practice Address - Street 2:SUITE 221
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2206
Practice Address - Country:US
Practice Address - Phone:305-595-4122
Practice Address - Fax:305-595-5908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN031921223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1033101027OtherNPI
FL1447242078OtherNPI