Provider Demographics
NPI:1669169199
Name:R KENDALL ROBERTS DDS PA
Entity type:Organization
Organization Name:R KENDALL ROBERTS DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MARNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-942-0204
Mailing Address - Street 1:PO BOX 306488
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6488
Mailing Address - Country:US
Mailing Address - Phone:615-942-0204
Mailing Address - Fax:
Practice Address - Street 1:5505 EUPER LN
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3233
Practice Address - Country:US
Practice Address - Phone:479-478-6060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty