Individual
DR. DIETMAR A KENNEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1504 BUDDY HOLLY AVE, LUBBOCK, TX 79401-5131
(806) 749-5437
(806) 744-7241
Mailing address
5601 COUNTY ROAD 1440, LUBBOCK, TX 79407-5785
(806) 438-0481
(806) 368-9984
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
19264
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1112112-02
—
TX
Enumeration date
08/07/2006
Last updated
02/02/2009
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