Organization
KENDALL S WOOLRIDGE D,D,S PC
Active
Other names
Grand Orthodontics
Organization subpart
No
Provider details
NPI number
Authorized official
KENDALL SHERRON WOOLRIDGE DDS (OWNER/DENTIST)
(310) 648-8781
Entity
Organization
Contact information
Practice address
310 E GRAND AVE STE 106, EL SEGUNDO, CA 90245-3871
(310) 648-8781
(310) 648-8776
Mailing address
310 E GRAND AVE STE 106, EL SEGUNDO, CA 90245-3871
(310) 648-8781
(310) 648-8776
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
57096
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104006196
INDIVIDUAL NPI
CA
01
—
1609159533
TYPE 2 NPI
CA
Enumeration date
02/23/2012
Last updated
10/05/2021
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