Healthcare Provider Details

I. General information

NPI: 1023930500
Provider Name (Legal Business Name): KENDALL ELISE LOCH D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 HOFF ST
FORT BENNING GA
31905-5645
US

IV. Provider business mailing address

7101 HOFF ST
FORT BENNING GA
31905-5645
US

V. Phone/Fax

Practice location:
  • Phone: 706-544-2051
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401420082
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: