=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336189422
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT OMER KENDIG D.D.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2006
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8010 RIDGE RD SUITE #1
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23229-7288
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-282-2323
-----------------------------------------------------
Fax | 804-282-0349
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8010 RIDGE RD SUITE #1
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23229-7288
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-282-2323
-----------------------------------------------------
Fax | 804-282-0349
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | 0401005243
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------