Provider Demographics
NPI:1831644269
Name:DAVID A. KILLEN, DDS, PS
Entity Type:Organization
Organization Name:DAVID A. KILLEN, DDS, PS
Other - Org Name:SMILEDENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:KILLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-481-8280
Mailing Address - Street 1:2020 MALTBY RD STE 9
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-8669
Mailing Address - Country:US
Mailing Address - Phone:425-481-8280
Mailing Address - Fax:
Practice Address - Street 1:2020 MALTBY RD STE 9
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-8669
Practice Address - Country:US
Practice Address - Phone:425-481-8280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00007721261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental