Most Relevant Information
Provider Data
| NPI Number: | 1003015496 |
| Provider Name: | KENNETH BYRON WILTBANK D.M.D. |
| Entity Type: | Individual |
| Taxonomy Code: | 122300000X |
| Specialty: | Dentist |
| License Number: | D7468 |
Most Important Dates
| Enumeration Date: | 07/16/2007 |
| Last Updated: | 07/16/2007 |
Provider Practice Location
320 A AVE
LAKE OSWEGO
OR
970343056
Practice Location Phone/Fax
| Phone: | 5036363383 |
| Fax: |
Provider Mailing Location
320 A AVENUE
LAKE OSWEGO
OR
97034
Provider Mailing Phone/Fax
| Phone: | 5036363383 |
| Fax: |