Provider Demographics
NPI:1538188172
Name:KENDALL, KELLY RAE (DDS)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:RAE
Last Name:KENDALL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1836 EAST ARRELLAGA
Mailing Address - Street 2:STE 101
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93103-2262
Mailing Address - Country:US
Mailing Address - Phone:805-687-2400
Mailing Address - Fax:877-307-7062
Practice Address - Street 1:1836 EAST ARRELLAGA
Practice Address - Street 2:STE 101
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93103-2262
Practice Address - Country:US
Practice Address - Phone:805-687-2400
Practice Address - Fax:877-307-7062
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA487521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice