Provider Demographics
NPI:1457618639
Name:FLANN, KENDRA (DMD)
Entity Type:Individual
Prefix:DR
First Name:KENDRA
Middle Name:
Last Name:FLANN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17680 SW HANDLEY ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-9299
Mailing Address - Country:US
Mailing Address - Phone:503-625-5437
Mailing Address - Fax:
Practice Address - Street 1:17680 SW HANDLEY ST STE 201
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-9299
Practice Address - Country:US
Practice Address - Phone:503-625-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD99751223P0221X
OR390200000390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program