Provider Demographics
NPI:1124103841
Name:KADOMA, WAKA (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:WAKA
Middle Name:
Last Name:KADOMA
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 E FRANKLIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-2811
Mailing Address - Country:US
Mailing Address - Phone:919-928-9392
Mailing Address - Fax:919-968-1025
Practice Address - Street 1:1525 E FRANKLIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2811
Practice Address - Country:US
Practice Address - Phone:919-928-9392
Practice Address - Fax:919-968-1025
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC69141223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics