Provider Demographics
NPI:1801028220
Name:KAY, MICHAEL A (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:KAY
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 1:862 COLE ST
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-2549
Mailing Address - Country:US
Mailing Address - Phone:360-825-2563
Mailing Address - Fax:360-825-2564
Practice Address - Street 1:862 COLE ST
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-2549
Practice Address - Country:US
Practice Address - Phone:360-825-2563
Practice Address - Fax:360-825-2564
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6324122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1083762496OtherNPI
WA6324OtherWASHINGTON STATE DENTAL LICENSE