Provider Demographics
NPI:1922169234
Name:KENDALL, WADE P (DDS)
Entity Type:Individual
Prefix:
First Name:WADE
Middle Name:P
Last Name:KENDALL
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 1:1200 12TH AVE S
Mailing Address - Street 2:SUITE 901
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-2712
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1200 12TH AVE S
Practice Address - Street 2:SUITE 401
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-2712
Practice Address - Country:US
Practice Address - Phone:206-548-5850
Practice Address - Fax:206-328-4034
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00010925122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist