Healthcare Provider Details

I. General information

NPI: 1336189422
Provider Name (Legal Business Name): ROBERT OMER KENDIG D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8010 RIDGE RD SUITE #1
RICHMOND VA
23229-7288
US

IV. Provider business mailing address

8010 RIDGE RD SUITE #1
RICHMOND VA
23229-7288
US

V. Phone/Fax

Practice location:
  • Phone: 804-282-2323
  • Fax: 804-282-0349
Mailing address:
  • Phone: 804-282-2323
  • Fax: 804-282-0349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number0401005243
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: