Healthcare Provider Details

I. General information

NPI: 1093004590
Provider Name (Legal Business Name): KERRY KENDRICK, DDS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 04/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 CHASE DR
HURRICANE WV
25526-8938
US

IV. Provider business mailing address

203 CHASE DR
HURRICANE WV
25526-8938
US

V. Phone/Fax

Practice location:
  • Phone: 304-757-7792
  • Fax: 304-757-7808
Mailing address:
  • Phone: 304-757-7792
  • Fax: 304-757-7808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number3175
License Number StateWV

VIII. Authorized Official

Name: KERRY L KENDRICK
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 304-757-7792