Michael A Kendall, D.M.D

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019.029862 Issued in IL

Practice address

401 Avenue of the Cities
East Moline, IL 61244-4024

Phone

(309) 755-1700

Fax

(309) 755-1788

NPI assigned

Aug 11, 2014

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• East Moline Dental Center PC

  • General Practice Dentistry
  • East Moline, IL
  • NPI 1265954598
  NPD Authorized official
• East Moline Dental Center PC

  dba Colona Dental Center

  • General Practice Dentistry
  • Colona, IL
  • NPI 1376014746
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1407715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1366851610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 AVENUE OF THE CITIES",
            "city": "EAST MOLINE",
            "state": "IL",
            "postal_code": "612444024",
            "telephone_number": "309-755-1700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 AVENUE OF THE CITIES",
            "city": "EAST MOLINE",
            "state": "IL",
            "postal_code": "612444024",
            "telephone_number": "309-755-1700",
            "fax_number": "309-755-1788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENDALL",
        "first_name": "MICHAEL",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "D.M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-08-11",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IA",
            "license": "09134",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.029862",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "019.029862",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LIC",
            "identifier": "09134",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carissa Anne Higley, PTA
• Hope Creek Nursing and Rehabilitation Center LLC
• Munawar Hussain, M.D.
• Individual Advocacy Group
• Melissa L Keith, DNP
• Amy Kernan
• Kevin C Dodson
• Kevin C. Dodson D.P.M.
• Alexander Edward Kincaid
• Peggy Jo Knaack, LCSW

• General Practice Dentistry in East Moline, IL
• Providers in East Moline, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.