Provider Demographics
NPI:1881700920
Name:KEVIN LEE DDS JOHANN TI DDS & MICHAEL HYODO DDS PLLC
Entity type:Organization
Organization Name:KEVIN LEE DDS JOHANN TI DDS & MICHAEL HYODO DDS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHANN
Authorized Official - Middle Name:M
Authorized Official - Last Name:TI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-629-1776
Mailing Address - Street 1:9612 270TH ST NW
Mailing Address - Street 2:7C
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292
Mailing Address - Country:US
Mailing Address - Phone:360-629-1776
Mailing Address - Fax:360-629-0541
Practice Address - Street 1:9612 270TH ST NW
Practice Address - Street 2:7C
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292
Practice Address - Country:US
Practice Address - Phone:360-629-1776
Practice Address - Fax:360-629-0541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6284261QD0000X
WA7741261QD0000X
WA9599261QD0000X
WA8211261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental