Provider Demographics
NPI:1043259674
Name:KANE, WENDY S
Entity type:Individual
Prefix:DR
First Name:WENDY
Middle Name:S
Last Name:KANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 ISLAND AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19153-2326
Mailing Address - Country:US
Mailing Address - Phone:215-492-8700
Mailing Address - Fax:215-492-0947
Practice Address - Street 1:2801 ISLAND AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19153-2326
Practice Address - Country:US
Practice Address - Phone:215-492-8700
Practice Address - Fax:215-492-0947
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS023518L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice