Ken W. Waddell, Dmd P.c.

NPI #1356530422 in Portland, Oregon

Provider Information

NPI Number: 1356530422
Entity Type: Organization
Organization Name: Ken W. Waddell, Dmd P.c.
Primary Specialty: Dentist - General Practice
Enumeration Date: Oct 15, 2007
Last Updated: Oct 15, 2007

Practice Location

Address: 15495 SW SEQUOIA PKWY
Address 2: SUITE 120
City: Portland
State: Oregon
ZIP Code: 97224-6100
Phone: (503) 684-8445

Authorized Official

Name: DR. KEN W WADDELL, DMD
Title: OWNER
Phone: (503) 684-8445

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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