Provider Demographics
NPI:1336205640
Name:BIEDERMAN, KEVIN D (DDS)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:D
Last Name:BIEDERMAN
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 1:7900 E GREEN LAKE DR N STE 300
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-4819
Mailing Address - Country:US
Mailing Address - Phone:206-859-2767
Mailing Address - Fax:206-859-2768
Practice Address - Street 1:7900 E GREEN LAKE DR N STE 300
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-4819
Practice Address - Country:US
Practice Address - Phone:951-203-9070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA000102281223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKDD3525Medicaid