MEDICARE: KENDZIOR ORTHODONTICS, PC

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1841729969
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENDZIOR ORTHODONTICS, PC

Provider Business Mailing Address
First Line	:	PO BOX 428
Second Line	:
City	:	RENO
State	:	PA
Zip	:	16343-0428
Country	:	US
Telephone Number	:	814-437-4377
Fax Number	:

Provider Business Practice Location Address
First Line	:	2119 ALLEGHENY BOULEVARD
Second Line	:
City	:	RENO
State	:	PA
Zip	:	16343
Country	:	US
Telephone Number	:	814-676-5690
Fax Number	:

Authorized Official
Title or Position	:	ORTHODONTIST
Name	:	DR. BRADLEY FULTON KENDZIOR
Credential	:	DDS, MS
Telephone Number	:	814-437-4377

Provider Enumeration Date	:	06/12/2017
Last Update Date	:	03/17/2018

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