Provider Demographics
NPI:1477087898
Name:KENDRICKS, BRYAN T (DMD, MD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:T
Last Name:KENDRICKS
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 N FOSTER ST SUITE 203
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303
Mailing Address - Country:US
Mailing Address - Phone:334-697-6453
Mailing Address - Fax:334-212-8467
Practice Address - Street 1:ALABAMA CENTER FOR ORAL SURGERY AND DENTAL IMPLANTS
Practice Address - Street 2:188 N FOSTER ST SUITE 203
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303
Practice Address - Country:US
Practice Address - Phone:334-697-6453
Practice Address - Fax:334-212-8467
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-12
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY99781223G0001X
ALD007143D204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral Practice