Provider Demographics
NPI:1336189422
Name:KENDIG, ROBERT OMER (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:OMER
Last Name:KENDIG
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 1:8010 RIDGE RD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-7288
Mailing Address - Country:US
Mailing Address - Phone:804-282-2323
Mailing Address - Fax:804-282-0349
Practice Address - Street 1:8010 RIDGE RD
Practice Address - Street 2:SUITE #1
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-7288
Practice Address - Country:US
Practice Address - Phone:804-282-2323
Practice Address - Fax:804-282-0349
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010052431223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8100047Medicaid
VA525434OtherUNITED CONCORDIA PROVIDER
VA006645OtherANTHEM PROVIDER #