Provider Demographics
NPI:1912446774
Name:KAHWACH, ANDRE-DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDRE-DAVID
Middle Name:
Last Name:KAHWACH
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:DEPT. OF ORAL & MAXILLOFACIAL SURGEY
Mailing Address - Street 2:1959 NE PACIFIC STREET, BOX 357134
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195
Mailing Address - Country:US
Mailing Address - Phone:424-232-6356
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF WASHINGTON DEPARTMENT OF ORAL
Practice Address - Street 2:1959 NE PACIFIC STREET
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-0001
Practice Address - Country:US
Practice Address - Phone:415-997-0004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-13
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WADR60753080204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program