Provider Demographics
NPI:1558519058
Name:BODA, KENDRA KAY (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:KENDRA
Middle Name:KAY
Last Name:BODA
Suffix:
Gender:F
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3004 GOLF RD STE 102
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-8794
Mailing Address - Country:US
Mailing Address - Phone:715-552-8165
Mailing Address - Fax:715-552-7931
Practice Address - Street 1:3004 GOLF RD STE 102
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-8794
Practice Address - Country:US
Practice Address - Phone:715-552-8165
Practice Address - Fax:715-552-7931
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND116331223E0200X
WI6901-151223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics