Provider Demographics
NPI:1578866406
Name:WASHINGTON, KELLEY MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:KELLEY
Middle Name:MICHAEL
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4543 RAINIER AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-1656
Mailing Address - Country:US
Mailing Address - Phone:206-722-8211
Mailing Address - Fax:206-722-3249
Practice Address - Street 1:4543 RAINIER AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-1656
Practice Address - Country:US
Practice Address - Phone:206-722-8211
Practice Address - Fax:206-722-3249
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA97211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice