Provider Demographics
NPI:1598824427
Name:KAI A MAULDING DDS PS
Entity type:Organization
Organization Name:KAI A MAULDING DDS PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KAI
Authorized Official - Middle Name:ANTONY
Authorized Official - Last Name:MAULDING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-357-6220
Mailing Address - Street 1:1212 E 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506
Mailing Address - Country:US
Mailing Address - Phone:360-357-6220
Mailing Address - Fax:360-352-5412
Practice Address - Street 1:1212 E 4TH AVE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506
Practice Address - Country:US
Practice Address - Phone:360-357-6220
Practice Address - Fax:360-352-5412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA88111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0205264OtherL & I
WA5047212OtherDSHS
WA11181OtherWASHINGTON DENTAL SERVICE