Provider Demographics
NPI:1700959251
Name:KENDRICK BREDE DMD
Entity Type:Organization
Organization Name:KENDRICK BREDE DMD
Other - Org Name:NEEDHAM LASER DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KENDRICK
Authorized Official - Middle Name:R
Authorized Official - Last Name:BREDE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-444-1505
Mailing Address - Street 1:1253 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492
Mailing Address - Country:US
Mailing Address - Phone:781-444-1505
Mailing Address - Fax:781-449-3231
Practice Address - Street 1:1253 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492
Practice Address - Country:US
Practice Address - Phone:781-444-1505
Practice Address - Fax:781-444-1505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA14790122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty