Provider Demographics
NPI:1669698916
Name:PENDLETON, DAVID KENT (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:KENT
Last Name:PENDLETON
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 1:307 CHILDRESS DR
Mailing Address - Street 2:
Mailing Address - City:ROCKDALE
Mailing Address - State:TX
Mailing Address - Zip Code:76567-2729
Mailing Address - Country:US
Mailing Address - Phone:512-446-5886
Mailing Address - Fax:512-446-0381
Practice Address - Street 1:307 CHILDRESS DR
Practice Address - Street 2:
Practice Address - City:ROCKDALE
Practice Address - State:TX
Practice Address - Zip Code:76567-2729
Practice Address - Country:US
Practice Address - Phone:512-446-5886
Practice Address - Fax:512-446-0381
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice