Provider Demographics
NPI:1306246202
Name:ISLAND PROSTHODONTICS
Entity type:Organization
Organization Name:ISLAND PROSTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:
Authorized Official - Last Name:KALLANDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-672-1790
Mailing Address - Street 1:20 SW 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-5314
Mailing Address - Country:US
Mailing Address - Phone:360-240-0800
Mailing Address - Fax:360-240-0881
Practice Address - Street 1:20 SW 8TH AVE
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-5314
Practice Address - Country:US
Practice Address - Phone:360-240-0800
Practice Address - Fax:360-240-0881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE0000057171223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty