Provider Demographics
NPI:1124295266
Name:RICKS, KENDELL HALES (DDS)
Entity type:Individual
Prefix:MR
First Name:KENDELL
Middle Name:HALES
Last Name:RICKS
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 1:8895 LAWRENCE WELK DR
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026
Mailing Address - Country:US
Mailing Address - Phone:760-749-7500
Mailing Address - Fax:760-749-0285
Practice Address - Street 1:8895 LAWRENCE WELK DR
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92026
Practice Address - Country:US
Practice Address - Phone:760-749-7500
Practice Address - Fax:760-749-0285
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA40717122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist