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General NPI Number Information
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NPI Number | 1467087320
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Entity Type | Organization
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Legal Business Name | KENLEY DENTAL
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Dates
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Enumeration Date | 03/10/2020
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Last Update Date | 03/10/2020
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Provider Practice Location Address
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Address Line | 281 N MAIN ST STE 201
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City | WASILLA
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State | AK
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Zip | 99654-7046
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Country | US
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Telephone | 435-757-6699
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Fax |
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Provider Business Mailing Address
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Address Line | 5200 N PALMER FISHHOOK RD
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City | PALMER
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State | AK
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Zip | 99645-8317
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Country | US
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Telephone | 435-757-6699
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | CALVIN MATTHEW KENLEY
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Credential | DMD
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Telephone | 435-757-6699
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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