Provider Demographics
NPI:1215018429
Name:KILLEN, DAVID A (DDS,)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:KILLEN
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 1:2020 MALTBY RD
Mailing Address - Street 2:SUITE #9
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-8669
Mailing Address - Country:US
Mailing Address - Phone:425-481-8280
Mailing Address - Fax:
Practice Address - Street 1:2020 MALTBY RD
Practice Address - Street 2:SUITE #9
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-8669
Practice Address - Country:US
Practice Address - Phone:425-481-8280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000077211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice