Provider Demographics
NPI:1669641098
Name:KENDALL ROBERTS DDS PC
Entity Type:Organization
Organization Name:KENDALL ROBERTS DDS PC
Other - Org Name:NEW HEALTH DENTAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:KENDALL
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-478-6060
Mailing Address - Street 1:5505 EUPER LANE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903
Mailing Address - Country:US
Mailing Address - Phone:479-478-6060
Mailing Address - Fax:479-478-6986
Practice Address - Street 1:5505 EUPER LANE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903
Practice Address - Country:US
Practice Address - Phone:479-478-6060
Practice Address - Fax:479-478-6986
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KENDALL ROBERTS DDS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR27871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty