Provider Demographics
NPI:1275796831
Name:KENDALL, TRAVIS L (DDS)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:L
Last Name:KENDALL
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 1:444 FOREST SQ
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-4463
Mailing Address - Country:US
Mailing Address - Phone:903-758-5551
Mailing Address - Fax:903-758-5877
Practice Address - Street 1:444 FOREST SQ
Practice Address - Street 2:SUITE 1
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-4463
Practice Address - Country:US
Practice Address - Phone:903-758-5551
Practice Address - Fax:903-758-5877
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57151122300000X
TX31729122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist