Provider Demographics
NPI:1831366301
Name:BIENFANG, KENDIL CREIGHTON (LSA)
Entity type:Individual
Prefix:MR
First Name:KENDIL
Middle Name:CREIGHTON
Last Name:BIENFANG
Suffix:
Gender:M
Credentials:LSA
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 57031
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-7031
Mailing Address - Country:US
Mailing Address - Phone:281-538-8706
Mailing Address - Fax:
Practice Address - Street 1:414 WINDHOLLOW CIR
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-5917
Practice Address - Country:US
Practice Address - Phone:281-538-8706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00030246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other