Individual
DR. CLARK KENNETH KVISTAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
21807 76TH AVE W, EDMONDS, WA 98026-7938
(425) 775-2002
Mailing address
21807 76TH AVE W, EDMONDS, WA 98026-7938
(425) 775-2002
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
3580
WA
Other
Enumeration date
09/03/2009
Last updated
09/03/2009
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