Healthcare Provider Details

I. General information

NPI: 1568253268
Provider Name (Legal Business Name): KENDAL W CARTER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48TH MDG/RAF LAKENHEATH
APO AE
09461
US

IV. Provider business mailing address

48TH MDG/RAF LAKENHEATH
APO AE
09461
US

V. Phone/Fax

Practice location:
  • Phone: 163-852-8010
  • Fax:
Mailing address:
  • Phone: 163-852-8010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14229051-9926
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: