Provider Demographics
NPI:1568783579
Name:SUZUKI, KEVIN RAY (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:RAY
Last Name:SUZUKI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13613 49TH AVENUE CT NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-8014
Mailing Address - Country:US
Mailing Address - Phone:484-213-0380
Mailing Address - Fax:
Practice Address - Street 1:2505 S 320TH ST
Practice Address - Street 2:SUITE 330
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-5400
Practice Address - Country:US
Practice Address - Phone:206-400-0800
Practice Address - Fax:253-874-9068
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 601086651223P0300X
PADS0381481223P0300X
FLDN 181241223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics