Provider Demographics
NPI:1467666990
Name:WAKEMAN, JOHN STANFORD (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:STANFORD
Last Name:WAKEMAN
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 1:278 A ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FRIDAY HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98250-7178
Mailing Address - Country:US
Mailing Address - Phone:360-378-5580
Mailing Address - Fax:360-378-5619
Practice Address - Street 1:278 A ST
Practice Address - Street 2:SUITE 1
Practice Address - City:FRIDAY HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98250-7178
Practice Address - Country:US
Practice Address - Phone:360-378-5580
Practice Address - Fax:360-378-5619
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000094361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice