Provider Demographics
NPI:1558890319
Name:KEY CENTER FAMILY DENTISTRY PLLC
Entity Type:Organization
Organization Name:KEY CENTER FAMILY DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:COZBY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:253-884-9455
Mailing Address - Street 1:9013 KEY PENINSULA HWY N
Mailing Address - Street 2:
Mailing Address - City:LAKEBAY
Mailing Address - State:WA
Mailing Address - Zip Code:98349-8518
Mailing Address - Country:US
Mailing Address - Phone:253-884-9455
Mailing Address - Fax:
Practice Address - Street 1:9013 KEY PENINSULA HWY N
Practice Address - Street 2:
Practice Address - City:LAKEBAY
Practice Address - State:WA
Practice Address - Zip Code:98349-8518
Practice Address - Country:US
Practice Address - Phone:253-884-9455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60369651122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty