Provider Demographics
NPI:1164622320
Name:ECKLAND, KEAGAN A (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEAGAN
Middle Name:A
Last Name:ECKLAND
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 1:17330 135TH AVE NE
Mailing Address - Street 2:SUITE 1-A
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-8522
Mailing Address - Country:US
Mailing Address - Phone:425-481-0755
Mailing Address - Fax:425-487-1578
Practice Address - Street 1:17330 135TH AVE NE
Practice Address - Street 2:SUITE 1-A
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-8522
Practice Address - Country:US
Practice Address - Phone:425-481-0755
Practice Address - Fax:425-487-1578
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000110441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice