Provider Demographics
NPI:1154673846
Name:DR FRANK KENDRICK DMD-HUNTERSVILLE PA
Entity Type:Organization
Organization Name:DR FRANK KENDRICK DMD-HUNTERSVILLE PA
Other - Org Name:SOUTH LAKE PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:YAIMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-875-9075
Mailing Address - Street 1:9625 NORTHCROSS CENTER CT
Mailing Address - Street 2:SUITE: 101
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-7348
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9625 NORTHCROSS CENTER CT
Practice Address - Street 2:SUITE: 101
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7348
Practice Address - Country:US
Practice Address - Phone:704-875-9075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC72211223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1386752061Medicaid