Healthcare Provider Details

I. General information

NPI: 1700702834
Provider Name (Legal Business Name): KENDALL ANN OLDHAM DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 S 11TH ST
MARION IA
52302-4962
US

IV. Provider business mailing address

577 N KIMBERLITE ST
TIFFIN IA
52340-9261
US

V. Phone/Fax

Practice location:
  • Phone: 319-456-4800
  • Fax:
Mailing address:
  • Phone: 847-899-0031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS-10515
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: