Provider Demographics
NPI:1497918429
Name:KIDS DENTIST, LLC
Entity Type:Organization
Organization Name:KIDS DENTIST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:DON
Authorized Official - Last Name:WENDELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:603-330-1990
Mailing Address - Street 1:16 WHITEHALL RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03867-3225
Mailing Address - Country:US
Mailing Address - Phone:603-330-1990
Mailing Address - Fax:603-330-3966
Practice Address - Street 1:16 WHITEHALL RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03867-3225
Practice Address - Country:US
Practice Address - Phone:603-330-1990
Practice Address - Fax:603-330-3966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH31341223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty