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General NPI Number Information
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NPI Number | 1609149533
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Entity Type | Organization
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Legal Business Name | KENDALL S WOOLRIDGE D,D,S PC
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Dates
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Enumeration Date | 02/23/2012
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Last Update Date | 10/05/2021
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Provider Practice Location Address
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Address Line | 310 E GRAND AVE STE 106
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City | EL SEGUNDO
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State | CA
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Zip | 90245-3871
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Country | US
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Telephone | 310-648-8781
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Fax | 310-648-8776
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Provider Business Mailing Address
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Address Line | 310 E GRAND AVE STE 106
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City | EL SEGUNDO
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State | CA
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Zip | 90245-3871
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Country | US
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Telephone | 310-648-8781
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Fax | 310-648-8776
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | KENDALL SHERRON WOOLRIDGE
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Credential | DDS
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Telephone | 310-648-8781
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 57096
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License Number State | CA
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