Provider Demographics
NPI:1467978239
Name:KIEL-FAVOR, PAULA JEAN (RDH)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:JEAN
Last Name:KIEL-FAVOR
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:JEAN
Other - Last Name:KIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1909 3RD ST SE
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98802-9259
Mailing Address - Country:US
Mailing Address - Phone:314-600-6475
Mailing Address - Fax:
Practice Address - Street 1:600 ORONDO AVE STE 1
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2800
Practice Address - Country:US
Practice Address - Phone:509-662-3860
Practice Address - Fax:509-664-4585
Is Sole Proprietor?:No
Enumeration Date:2017-08-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHL00007994124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist