Provider Demographics
NPI:1083782791
Name:DUNG, KEITH A (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:A
Last Name:DUNG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11545 15TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-6358
Mailing Address - Country:US
Mailing Address - Phone:206-362-5505
Mailing Address - Fax:206-362-3083
Practice Address - Street 1:11545 15TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-6358
Practice Address - Country:US
Practice Address - Phone:206-362-5505
Practice Address - Fax:206-362-3083
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00006852122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist