Provider Demographics
NPI:1326566241
Name:KAYLEE WONDER DMD PLLC
Entity Type:Organization
Organization Name:KAYLEE WONDER DMD PLLC
Other - Org Name:WONDER FAMILY DENTAL & DENTURES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAYLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:WONDER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:360-779-1566
Mailing Address - Street 1:19410 8TH AVE NE STE 102
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-7379
Mailing Address - Country:US
Mailing Address - Phone:360-779-1566
Mailing Address - Fax:
Practice Address - Street 1:19410 8TH AVE NE STE 102
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-7379
Practice Address - Country:US
Practice Address - Phone:360-779-1566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60771805261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental