Provider Demographics
NPI:1740378223
Name:LIDAY, KENDALL RAE (DDS)
Entity type:Individual
Prefix:DR
First Name:KENDALL
Middle Name:RAE
Last Name:LIDAY
Suffix:
Gender:F
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:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:SCAPPOOSE
Mailing Address - State:OR
Mailing Address - Zip Code:97056-0550
Mailing Address - Country:US
Mailing Address - Phone:503-543-4949
Mailing Address - Fax:503-543-7152
Practice Address - Street 1:33640 E COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:SCAPPOOSE
Practice Address - State:OR
Practice Address - Zip Code:97056
Practice Address - Country:US
Practice Address - Phone:503-543-4949
Practice Address - Fax:503-543-7152
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD84581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice