Provider Demographics
NPI:1922028935
Name:GARWOOD, KELLY RAE (DDS)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:RAE
Last Name:GARWOOD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:RAE
Other - Last Name:GARWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 372
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98045
Mailing Address - Country:US
Mailing Address - Phone:425-888-0867
Mailing Address - Fax:425-888-6585
Practice Address - Street 1:142 MAIN AVE N
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:WA
Practice Address - Zip Code:98045
Practice Address - Country:US
Practice Address - Phone:425-888-0867
Practice Address - Fax:425-888-6585
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000080631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice