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General NPI Number Information
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NPI Number | 1013926955
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Entity Type | Individual
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Provider Name | DIETMAR A KENNEL DDS
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Gender | Male
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Dates
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Enumeration Date | 08/07/2006
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Last Update Date | 02/02/2009
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Provider Practice Location Address
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Address Line | 1504 BUDDY HOLLY AVE
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City | LUBBOCK
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State | TX
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Zip | 79401-5131
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Country | US
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Telephone | 806-749-5437
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Fax | 806-744-7241
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Provider Business Mailing Address
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Address Line | 5601 COUNTY ROAD 1440
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City | LUBBOCK
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State | TX
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Zip | 79407-5785
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Country | US
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Telephone | 806-438-0481
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Fax | 806-368-9984
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 19264
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License Number State | TX
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