Provider Demographics
NPI:1609539451
Name:KENDALL DENTAL ASSOCIATES GROUP LLC
Entity Type:Organization
Organization Name:KENDALL DENTAL ASSOCIATES GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:FAGET
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-271-1421
Mailing Address - Street 1:8833 SW 107TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1411
Mailing Address - Country:US
Mailing Address - Phone:305-271-1421
Mailing Address - Fax:
Practice Address - Street 1:8833 SW 107TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1411
Practice Address - Country:US
Practice Address - Phone:305-271-1421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty