Provider Demographics
NPI:1073203485
Name:KO DENTAL
Entity Type:Organization
Organization Name:KO DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEANA
Authorized Official - Middle Name:
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-624-7706
Mailing Address - Street 1:600 UNIVERSITY ST STE 819
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-4117
Mailing Address - Country:US
Mailing Address - Phone:206-624-7706
Mailing Address - Fax:206-264-0527
Practice Address - Street 1:600 UNIVERSITY ST STE 819
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-4117
Practice Address - Country:US
Practice Address - Phone:206-624-7706
Practice Address - Fax:206-264-0527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty