Provider Demographics
NPI:1194866830
Name:KENDRICK, STEVEN MICHAEL (DDS)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:MICHAEL
Last Name:KENDRICK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 S POST RD
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-4618
Mailing Address - Country:US
Mailing Address - Phone:405-732-0431
Mailing Address - Fax:045-732-0431
Practice Address - Street 1:570 S POST RD
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-4618
Practice Address - Country:US
Practice Address - Phone:405-732-0431
Practice Address - Fax:045-732-0431
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK55501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100097350AOtherMEDICAID