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 1:6874 W 9530 N
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:UT
Mailing Address - Zip Code:84003-3568
Mailing Address - Country:US
Mailing Address - Phone:208-989-2370
Mailing Address - Fax:
Practice Address - Street 1:6874 W 9530 N
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:UT
Practice Address - Zip Code:84003-3568
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:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14020430-99261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice