Provider Demographics
NPI:1376040485
Name:KENDALL, DARLISA M (DENTAL HYGENIST)
Entity Type:Individual
Prefix:
First Name:DARLISA
Middle Name:M
Last Name:KENDALL
Suffix:
Gender:F
Credentials:DENTAL HYGENIST
Other - Prefix:
Other - First Name:DARLISA
Other - Middle Name:M
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DENTAL HYGENIST
Mailing Address - Street 1:800 E 55TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-4906
Mailing Address - Country:US
Mailing Address - Phone:773-795-2260
Mailing Address - Fax:773-834-3756
Practice Address - Street 1:5635 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-4438
Practice Address - Country:US
Practice Address - Phone:773-585-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL020.011820124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist