Provider Demographics
NPI:1558105742
Name:LAW, KENDRA (DDS)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:LAW
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 1:3903 DEQUATTRO DR UNIT 5202
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-7513
Mailing Address - Country:US
Mailing Address - Phone:208-989-2370
Mailing Address - Fax:
Practice Address - Street 1:4245 N COURTENAY PKWY
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-8198
Practice Address - Country:US
Practice Address - Phone:208-989-2370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-21
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN30257122300000X
UT14020430-99261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral Practice