Healthcare Provider Details

I. General information

NPI: 1699329854
Provider Name (Legal Business Name): KENDRICK JORDAN SAWYERS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2019
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5979 DESERT STORM AVE
FORT CAMPBELL KY
42223-5514
US

IV. Provider business mailing address

342 CROOKED CREEK LN
HENDERSONVILLE TN
37075-6743
US

V. Phone/Fax

Practice location:
  • Phone: 270-412-2787
  • Fax:
Mailing address:
  • Phone: 910-849-0898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number11448
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number13091
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: