Provider Demographics
NPI:1467768580
Name:FRANK KENDRICK DMD PA
Entity Type:Organization
Organization Name:FRANK KENDRICK DMD PA
Other - Org Name:EASTFIELD PEDIATRIC DENTISTRY & ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST & OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:KENDRICK
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:704-875-9075
Mailing Address - Street 1:8631 ARBOR CREEK DR STE D3
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-0548
Mailing Address - Country:US
Mailing Address - Phone:704-875-9075
Mailing Address - Fax:704-875-9055
Practice Address - Street 1:8631 ARBOR CREEK DR STE D3
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-0548
Practice Address - Country:US
Practice Address - Phone:704-875-9075
Practice Address - Fax:704-875-9055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1386752061OtherNPI TYPE 1
NC5902967Medicaid