MEDICARE: KENDRA WHITE HYGENTIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	DH010417	GA

General Provider Information

NPI Number	:	1689459919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDRA WHITE HYGENTIST

Provider Business Mailing Address
First Line	:	4652 CREEKSIDE VILLAS WAY SE
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30082-4895
Country	:	US
Telephone Number	:	404-495-4734
Fax Number	:

Provider Business Practice Location Address
First Line	:	1188 RALPH DAVID ABERNATHY BLVD SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30310-1716
Country	:	US
Telephone Number	:	404-564-7749
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2023
Last Update Date	:	08/25/2023

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