Provider Demographics
NPI:1477567295
Name:KENDRICK, JEFFERY ALAN (DMD)
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:ALAN
Last Name:KENDRICK
Suffix:
Gender:M
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:PO BOX 38
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214
Mailing Address - Country:US
Mailing Address - Phone:770-460-9795
Mailing Address - Fax:770-460-7536
Practice Address - Street 1:171 PRICE RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215-2016
Practice Address - Country:US
Practice Address - Phone:770-460-9795
Practice Address - Fax:770-460-7536
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0116991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice