=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700702834
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KENDALL ANN OLDHAM DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2026
-----------------------------------------------------
Last Update Date | 06/24/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 675 S 11TH ST
-----------------------------------------------------
City | MARION
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52302-4962
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-456-4800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 577 N KIMBERLITE ST
-----------------------------------------------------
City | TIFFIN
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52340-9261
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-899-0031
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DDS-10515
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------