Provider Demographics
NPI:1659724292
Name:KRISTI R. DONLEY, D.D.S., PLLC
Entity Type:Organization
Organization Name:KRISTI R. DONLEY, D.D.S., PLLC
Other - Org Name:EASTSIDE ENDODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:DONLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-391-0700
Mailing Address - Street 1:1105 12TH AVE NW
Mailing Address - Street 2:STE #A-1A
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-8986
Mailing Address - Country:US
Mailing Address - Phone:425-391-0700
Mailing Address - Fax:425-391-3332
Practice Address - Street 1:1105 12TH AVE NW
Practice Address - Street 2:STE #A-1A
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-8986
Practice Address - Country:US
Practice Address - Phone:425-391-0700
Practice Address - Fax:425-391-3332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000100211223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty