Provider Demographics
NPI:1386658748
Name:KENDRICK, COLLEEN PATRICIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:PATRICIA
Last Name:KENDRICK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1916 WELSH RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-4655
Mailing Address - Country:US
Mailing Address - Phone:215-676-2311
Mailing Address - Fax:215-676-7193
Practice Address - Street 1:1916 WELSH RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-4655
Practice Address - Country:US
Practice Address - Phone:215-676-2311
Practice Address - Fax:215-676-7193
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028099L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist