Provider Demographics
NPI:1841729969
Name:KENDZIOR ORTHODONTICS, PC
Entity type:Organization
Organization Name:KENDZIOR ORTHODONTICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:FULTON
Authorized Official - Last Name:KENDZIOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:814-437-4377
Mailing Address - Street 1:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:PA
Mailing Address - Zip Code:16343-0428
Mailing Address - Country:US
Mailing Address - Phone:814-437-4377
Mailing Address - Fax:
Practice Address - Street 1:2119 ALLEGHENY BOULEVARD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:PA
Practice Address - Zip Code:16343
Practice Address - Country:US
Practice Address - Phone:814-676-5690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty