Provider Demographics
NPI:1659496529
Name:WENDELL, KEVIN JAMES (DDS)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:JAMES
Last Name:WENDELL
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 1:7 THAYER ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-1018
Mailing Address - Country:US
Mailing Address - Phone:401-439-4213
Mailing Address - Fax:
Practice Address - Street 1:40 CUMBERLAND AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:NORTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02760-4445
Practice Address - Country:US
Practice Address - Phone:508-399-8800
Practice Address - Fax:508-388-7744
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA211811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice