Provider Demographics
NPI:1942338835
Name:KENDALL, CARSON SHERROD (DDS)
Entity type:Individual
Prefix:MR
First Name:CARSON
Middle Name:SHERROD
Last Name:KENDALL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5708 SOUTH 6TH ST
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603
Mailing Address - Country:US
Mailing Address - Phone:541-882-7492
Mailing Address - Fax:541-850-8376
Practice Address - Street 1:5708 SOUTH 6TH ST
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603
Practice Address - Country:US
Practice Address - Phone:541-882-7492
Practice Address - Fax:541-850-8376
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5003122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist