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General NPI Number Information
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NPI Number | 1891185526
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Entity Type | Organization
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Legal Business Name | KENDALL HOMER D.M.D., INC.
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Dates
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Enumeration Date | 02/03/2015
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Last Update Date | 02/03/2015
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Provider Practice Location Address
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Address Line | 9216 KIEFER BLVD. SUITE 5
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City | SACRAMENTO
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State | CA
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Zip | 95826-5418
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Country | US
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Telephone | 916-363-9171
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Fax | 916-363-9173
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Provider Business Mailing Address
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Address Line | 9216 KIEFER BLVD. SUITE 5
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City | SACRAMENTO
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State | CA
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Zip | 95826-5418
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Country | US
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Telephone | 916-363-9171
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Fax | 916-363-9173
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Authorized Official
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Title or Position | CORPORATE OFFICER/ DENTIST
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Name | MR. KENDALL DON HOMER
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Credential | D.M.D.
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Telephone | 916-363-9171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 58930
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 32428
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License Number State | CA
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