Provider Demographics
NPI:1699873695
Name:KENDALL, SIGURD SCRIVEN (DDS)
Entity type:Individual
Prefix:DR
First Name:SIGURD
Middle Name:SCRIVEN
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 1:110 E VILLA MARIA RD
Mailing Address - Street 2:
Mailing Address - City:BRIAN
Mailing Address - State:TX
Mailing Address - Zip Code:77801-3147
Mailing Address - Country:US
Mailing Address - Phone:979-779-6146
Mailing Address - Fax:979-779-6250
Practice Address - Street 1:110 E VILLA MARIA RD
Practice Address - Street 2:
Practice Address - City:BRIAN
Practice Address - State:TX
Practice Address - Zip Code:77801-3147
Practice Address - Country:US
Practice Address - Phone:979-779-6146
Practice Address - Fax:979-779-6250
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice