Provider Demographics
NPI:1487656518
Name:KONDO, MICHAEL E (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:E
Last Name:KONDO
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 1:4610 N ASH ST
Mailing Address - Street 2:STE 201
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-1482
Mailing Address - Country:US
Mailing Address - Phone:509-325-4313
Mailing Address - Fax:509-325-3919
Practice Address - Street 1:4610 N ASH ST
Practice Address - Street 2:STE 201
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-1482
Practice Address - Country:US
Practice Address - Phone:509-325-4313
Practice Address - Fax:509-325-3919
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA4945122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5515804Medicaid