MEDICARE: MICHAEL E. KONDO DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	4945	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487656518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL E. KONDO DDS

Provider Business Mailing Address
First Line	:	4610 N ASH ST
Second Line	:	STE 201
City	:	SPOKANE
State	:	WA
Zip	:	99205-1482
Country	:	US
Telephone Number	:	509-325-4313
Fax Number	:	509-325-3919

Provider Business Practice Location Address
First Line	:	4610 N ASH ST
Second Line	:	STE 201
City	:	SPOKANE
State	:	WA
Zip	:	99205-1482
Country	:	US
Telephone Number	:	509-325-4313
Fax Number	:	509-325-3919

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	07/08/2007

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