Provider Demographics
NPI:1861027732
Name:SANDS, KENDALL THOMAS
Entity Type:Individual
Prefix:DR
First Name:KENDALL
Middle Name:THOMAS
Last Name:SANDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 FAXON AVE APT 1003
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4688
Mailing Address - Country:US
Mailing Address - Phone:478-718-9942
Mailing Address - Fax:
Practice Address - Street 1:508 INDIANA AVE # 3106
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-3106
Practice Address - Country:US
Practice Address - Phone:317-269-0402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-11
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36005122300000X
IN12013328A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist