# KENDALL IMPLANT AND ORAL SURGERY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1437779691
- **Authorized official:** CHARLES LEE CLARK DDS (OWNER)
- **Authorized official phone:** (830) 331-2007

## Contact information

- **Practice address:** 109 FALLS CT STE 700, BOERNE, TX 78006-2984
- **Practice address phone:** (830) 331-2007
- **Practice address fax:** (830) 331-2009
- **Mailing address:** 109 FALLS CT STE 700, BOERNE, TX 78006-2984
- **Mailing address phone:** (830) 331-2007
- **Mailing address fax:** (830) 331-2009

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 04/17/2020
- **Last updated:** 04/17/2020