Individual
DR. KENNETH BYRON WILTBANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
320 A AVE, LAKE OSWEGO, OR 97034-3056
(503) 636-3383
Mailing address
320 A AVENUE, LAKE OSWEGO, OR 97034
(503) 636-3383
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D7468
OR
Other
Enumeration date
07/16/2007
Last updated
07/16/2007
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