Doctor Name: | DR. DIETMAR A KENNEL |
NPI Number: | 1013926955 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DDS |
License Number: | 19264 |
Business Practice Address: | 1504 Buddy Holly Ave Lubbock, TX - 794015131 |
Business Phone Number: | 8067495437 |
Business Fax Number: | 8067447241 |
Mailing Address: | 5601 County Road 1440, LUBBOCK |
State: | TX |
Postal Code: | 794075785 |
Phone Number: | 8064380481 |
Fax Number: | 8063689984 |
NPI Enumeration Date: | 08/07/2006 |
NPI Last Update Date: | 02/02/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1223P0221X |
License Number: | 19264 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Dental Providers |
Taxonomy Classification: | Dentist |
Taxonomy Specialization: | Pediatric Dentistry |
Taxonomy Definition: | An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |