Provider Demographics
NPI:1285644369
Name:MCNABB, KEN JACK (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEN
Middle Name:JACK
Last Name:MCNABB
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7711 16TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-4363
Mailing Address - Country:US
Mailing Address - Phone:206-718-1918
Mailing Address - Fax:
Practice Address - Street 1:7711 16TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-4332
Practice Address - Country:US
Practice Address - Phone:206-718-1918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00009142122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist