Provider Demographics
NPI:1144605510
Name:AMY KENDALL DROUIN, DMD PC
Entity Type:Organization
Organization Name:AMY KENDALL DROUIN, DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:DENTINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-882-7492
Mailing Address - Street 1:5708 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-5108
Mailing Address - Country:US
Mailing Address - Phone:541-882-7492
Mailing Address - Fax:541-850-8376
Practice Address - Street 1:5708 S 6TH ST
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-5108
Practice Address - Country:US
Practice Address - Phone:541-882-7492
Practice Address - Fax:541-850-8376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8806122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty