Healthcare Provider Details

I. General information

NPI: 1922169234
Provider Name (Legal Business Name): WADE P. KENDALL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 06/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 12TH AVE S SUITE 401
SEATTLE WA
98144-2712
US

IV. Provider business mailing address

1200 12TH AVE S SUITE 901
SEATTLE WA
98144-2712
US

V. Phone/Fax

Practice location:
  • Phone: 206-548-5850
  • Fax: 206-328-4034
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE00010925
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: