Individual
DR. KEN WAYNE WADDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
15495 SW SEQUOIA PKWY, SUITE 120, PORTLAND, OR 97224-6100
(503) 684-8445
Mailing address
15495 SW SEQUOIA PKWY, SUITE 120, PORTLAND, OR 97224-6100
(503) 684-8445
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D5796
OR
Other
Enumeration date
08/30/2006
Last updated
07/08/2007
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