Kendall S Woolridge D,D,S PC

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

57096 Issued in CA

Legal business name

KENDALL S WOOLRIDGE D,D,S PC

Doing business as

Grand Orthodontics

Practice address

310 E Grand Ave Ste 106
El Segundo, CA 90245-3871

Phone

(310) 648-8781

Fax

(310) 648-8776

NPI assigned

Feb 23, 2012

Organization subpart

No

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

Authorized official

Name

Kendall Sherron Woolridge, DDSNPI 1104006196

Title

Owner/Dentist

Phone

(310) 648-8781

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Grand Orthodontics Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kendall Sherron Woolridge, D.D.S.

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • El Segundo, CA
  • NPI 1104006196
  NPD Authorized official

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

{
    "created_epoch": "1329955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633392000000",
    "number": "1609149533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 E GRAND AVE STE 106",
            "city": "EL SEGUNDO",
            "state": "CA",
            "postal_code": "902453871",
            "telephone_number": "310-648-8781",
            "fax_number": "310-648-8776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 E GRAND AVE STE 106",
            "city": "EL SEGUNDO",
            "state": "CA",
            "postal_code": "902453871",
            "telephone_number": "310-648-8781",
            "fax_number": "310-648-8776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENDALL S WOOLRIDGE D,D,S PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-23",
        "last_updated": "2021-10-05",
        "certification_date": "2021-10-05",
        "status": "A",
        "authorized_official_last_name": "WOOLRIDGE",
        "authorized_official_first_name": "KENDALL",
        "authorized_official_middle_name": "SHERRON",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "310-648-8781",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "CA",
            "license": "57096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1104006196",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TYPE 2 NPI",
            "identifier": "1609159533",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grand Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Grand Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Genesis Kekoa
• Lauren Kelley
• Nicole Kelley
• Lily Kelly
• Madison Kelm
• Lisa Kendrick, RON
• Daishane Kendrix
• Jewel Kennedy
• Tanisha Kennedy
• Logan Kenny

• Orthodontics and Dentofacial Orthopedics Dentistry in El Segundo, CA
• Providers in El Segundo, CA by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2021; 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.