Provider Demographics
NPI:1790847176
Name:KIRKENDALL, BRENDA (DDS)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:KIRKENDALL
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 5306
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35814-5306
Mailing Address - Country:US
Mailing Address - Phone:256-536-8561
Mailing Address - Fax:256-536-8563
Practice Address - Street 1:2310 WHITESBURG DR S
Practice Address - Street 2:#2
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3845
Practice Address - Country:US
Practice Address - Phone:256-536-8561
Practice Address - Fax:256-536-8563
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL44411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51519698OtherBCBS OF ALABAMA ID NUMBER