Provider Demographics
NPI:1871294793
Name:SMITH, KENDRA KAY DAVIS (RDH)
Entity type:Individual
Prefix:
First Name:KENDRA KAY
Middle Name:DAVIS
Last Name:SMITH
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:KAY
Other - Last Name:PELHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:29709 HARDESTY RD
Mailing Address - Street 2:
Mailing Address - City:MCLOUD
Mailing Address - State:OK
Mailing Address - Zip Code:74851-8589
Mailing Address - Country:US
Mailing Address - Phone:405-765-6768
Mailing Address - Fax:
Practice Address - Street 1:7050 AIR DEPOT BLVD STE 1094
Practice Address - Street 2:
Practice Address - City:TINKER AFB
Practice Address - State:OK
Practice Address - Zip Code:73145-8716
Practice Address - Country:US
Practice Address - Phone:405-734-2778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4031124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist