Provider Demographics
NPI:1093823510
Name:KATHERINE MCKINNEY DDS PS
Entity Type:Organization
Organization Name:KATHERINE MCKINNEY DDS PS
Other - Org Name:DENTISTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:MAYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-284-0515
Mailing Address - Street 1:5726 LAKE WASHINGTON BLVD NE STE S2
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-7398
Mailing Address - Country:US
Mailing Address - Phone:425-284-0515
Mailing Address - Fax:425-284-0516
Practice Address - Street 1:5726 LAKE WASHINGTON BLVD NE STE S2
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-7398
Practice Address - Country:US
Practice Address - Phone:425-284-0515
Practice Address - Fax:425-284-0516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA9147122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered122300000XDental ProvidersDentistGroup - Single Specialty
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty