Provider Demographics
NPI:1619057346
Name:SHIPP, KENDAL HAMMONS (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENDAL
Middle Name:HAMMONS
Last Name:SHIPP
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 MEDICAL DRIVE SUITE 200
Mailing Address - Street 2:
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78734
Mailing Address - Country:US
Mailing Address - Phone:512-368-6165
Mailing Address - Fax:512-367-5732
Practice Address - Street 1:1945 MEDICAL DRIVE SUITE 200
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734
Practice Address - Country:US
Practice Address - Phone:512-368-6165
Practice Address - Fax:512-367-5732
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX178681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice