Provider Demographics
NPI:1336369958
Name:KIRKENDALL, DALE (DDS)
Entity Type:Individual
Prefix:MR
First Name:DALE
Middle Name:
Last Name:KIRKENDALL
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 1:471 N SAN GORGONIO AVE
Mailing Address - Street 2:
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220-5523
Mailing Address - Country:US
Mailing Address - Phone:951-849-2888
Mailing Address - Fax:951-849-1454
Practice Address - Street 1:471 N SAN GORGONIO AVE
Practice Address - Street 2:
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-5523
Practice Address - Country:US
Practice Address - Phone:951-849-2888
Practice Address - Fax:951-849-1454
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA155321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9202802OtherDENTICAL
CAG9202801OtherDENTICAL