Provider Demographics
NPI:1205114337
Name:OUSLEY, KENDRA NICOLE (DMD)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:NICOLE
Last Name:OUSLEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:NICOLE
Other - Last Name:CHAPMAN-SMALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:422 VIRGINIA RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-4793
Mailing Address - Country:US
Mailing Address - Phone:217-415-2300
Mailing Address - Fax:
Practice Address - Street 1:12460 CRABAPPLE RD STE 801
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-6391
Practice Address - Country:US
Practice Address - Phone:770-360-9131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-22
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO106681223G0001X
GADN0157351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice