Provider Demographics
NPI:1518292366
Name:KENDRA H. YANDELL DDS PC
Entity Type:Organization
Organization Name:KENDRA H. YANDELL DDS PC
Other - Org Name:HAMMOND FAMILY DENITSTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:HAMMOND
Authorized Official - Last Name:YANDELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-647-4636
Mailing Address - Street 1:PO BOX 729
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-0729
Mailing Address - Country:US
Mailing Address - Phone:918-647-4636
Mailing Address - Fax:918-647-8305
Practice Address - Street 1:502 DEWEY AVE
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-4216
Practice Address - Country:US
Practice Address - Phone:918-647-4636
Practice Address - Fax:918-647-8305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK60511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty