Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 61435 | KS |
NPI | 1144714338 |
---|---|
Provider Name | Dr. Charles Kendall |
First Address | Shawnee, KS 66216-2293 |
Second Address | Lawrence, KS 66049-3838 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2018 |
Last Update Date | 20/06/2018 |