Provider Demographics
NPI:1811977747
Name:KENDRICK, CHARLES THOMAS (MD, DMD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:THOMAS
Last Name:KENDRICK
Suffix:
Gender:M
Credentials:MD, DMD
Other - Prefix:
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Mailing Address - Street 1:80 HANNAH NILES WAY
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-7260
Mailing Address - Country:US
Mailing Address - Phone:781-356-2120
Mailing Address - Fax:781-356-2120
Practice Address - Street 1:30 WARREN ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-3602
Practice Address - Country:US
Practice Address - Phone:617-254-3800
Practice Address - Fax:617-779-1509
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2007-09-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA82014207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAH07657Medicare UPIN