Provider Demographics
NPI:1568564557
Name:KANE, WENDELL S (DMD)
Entity Type:Individual
Prefix:
First Name:WENDELL
Middle Name:S
Last Name:KANE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 W MONROE AVE
Mailing Address - Street 2:SUITE #3
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-5814
Mailing Address - Country:US
Mailing Address - Phone:314-821-1496
Mailing Address - Fax:
Practice Address - Street 1:131 W MONROE AVE
Practice Address - Street 2:SUITE #3
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-5814
Practice Address - Country:US
Practice Address - Phone:314-821-1496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0149021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice