Provider Demographics
NPI:1841603412
Name:KENDZIORSKI, BRENT (DDS)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:
Last Name:KENDZIORSKI
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 1:1185 US HIGHWAY 23 N
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-8004
Mailing Address - Country:US
Mailing Address - Phone:989-356-4049
Mailing Address - Fax:989-358-3713
Practice Address - Street 1:1185 US HIGHWAY 23 N
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-8004
Practice Address - Country:US
Practice Address - Phone:989-356-4049
Practice Address - Fax:989-358-3713
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010212231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice