Healthcare Provider Details

I. General information

NPI: 1073177531
Provider Name (Legal Business Name): KENDALL DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2019
Last Update Date: 05/20/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 RICE ROAD SUITE 100
TYLER TX
75703-3224
US

IV. Provider business mailing address

1520 RICE ROAD SUITE 100
TYLER TX
75703-3224
US

V. Phone/Fax

Practice location:
  • Phone: 903-597-2201
  • Fax: 903-597-2282
Mailing address:
  • Phone: 903-597-2201
  • Fax: 903-597-2282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. TRAVIS L KENDALL
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 903-597-2201