Provider Demographics
NPI:1215013602
Name:MOBERLY, D. KENT (DMD)
Entity Type:Individual
Prefix:DR
First Name:D. KENT
Middle Name:
Last Name:MOBERLY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 W MCGRAW ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98199-3246
Mailing Address - Country:US
Mailing Address - Phone:206-283-2400
Mailing Address - Fax:206-283-0385
Practice Address - Street 1:3300 W MCGRAW ST
Practice Address - Street 2:SUITE 240
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98199-3246
Practice Address - Country:US
Practice Address - Phone:206-283-2400
Practice Address - Fax:206-283-0385
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000055271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice