Provider Demographics
NPI:1972829661
Name:MAULDING, KAI A (DDS)
Entity Type:Individual
Prefix:DR
First Name:KAI
Middle Name:A
Last Name:MAULDING
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 1:1212 4TH AVE E
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-4212
Mailing Address - Country:US
Mailing Address - Phone:360-357-6220
Mailing Address - Fax:360-352-5412
Practice Address - Street 1:1212 4TH AVE E
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-4212
Practice Address - Country:US
Practice Address - Phone:360-357-6220
Practice Address - Fax:360-352-5412
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA88111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5042148Medicaid