Dr. Clark Kenneth Kvistad
Periodontist
21807 76th Ave W
Edmonds
, Washington 98026-7938
Dr. Clark Kenneth Kvistad
Periodontist
21807 76th Ave W
Edmonds
, Washington 98026-7938
(425) 775-2002
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About
Features
Specialties
- Periodontist
Languages spoken
- English
Location
First Address
- Dr. Clark Kenneth Kvistad
- 21807 76th Ave W
- Edmonds, WA
- Zip : 98026-7938
- Phone : (425) 775-2002
Second Address
- Dr. Clark Kenneth Kvistad
- 21807 76th Ave W
- Edmonds, WA
- Zip : 98026-7938
- Phone : (425) 775-2002
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 1223P0300X | Periodontist | 3580 | WA |
National Provider Identifier
| NPI | 1093948267 |
|---|---|
| Provider Name | Dr. Clark Kenneth Kvistad |
| First Address | Edmonds, WA 98026-7938 |
| Second Address | Edmonds, WA 98026-7938 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 03/09/2009 |
| Last Update Date | 03/09/2009 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.