Provider Demographics
NPI:1619680170
Name:DEKREEK, KENDALL ABRAHAM (DDS)
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:ABRAHAM
Last Name:DEKREEK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9048 BROOKS RD S
Mailing Address - Street 2:PMB 167
Mailing Address - City:WINDSOR
Mailing Address - State:CA
Mailing Address - Zip Code:95492-7811
Mailing Address - Country:US
Mailing Address - Phone:805-657-2487
Mailing Address - Fax:
Practice Address - Street 1:6230 STATE FARM DR
Practice Address - Street 2:
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-2120
Practice Address - Country:US
Practice Address - Phone:707-795-4523
Practice Address - Fax:707-586-1650
Is Sole Proprietor?:No
Enumeration Date:2022-12-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS107893122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist