Healthcare Provider Details

I. General information

NPI: 1386658748
Provider Name (Legal Business Name): COLLEEN PATRICIA KENDRICK DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1916 WELSH RD
PHILADELPHIA PA
19115-4655
US

IV. Provider business mailing address

1916 WELSH RD
PHILADELPHIA PA
19115-4655
US

V. Phone/Fax

Practice location:
  • Phone: 215-676-2311
  • Fax: 215-676-7193
Mailing address:
  • Phone: 215-676-2311
  • Fax: 215-676-7193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS028099L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: