Provider Demographics
NPI:1508966276
Name:O'HAVER, WENDY JOHNSON (DDS)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:JOHNSON
Last Name:O'HAVER
Suffix:
Gender:F
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:PO BOX 34703
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3712 S CEDAR ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-5715
Practice Address - Country:US
Practice Address - Phone:253-682-2860
Practice Address - Fax:253-682-2191
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603505251223G0001X
CO90361223G0001X
WADE60350525122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice