MEDICARE: DKEIDEK, FERNYHOUGH, GILE, HAGEL, NOV & QUICKSTAD PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1619834686
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DKEIDEK, FERNYHOUGH, GILE, HAGEL, NOV & QUICKSTAD PLLC

Provider Business Mailing Address
First Line	:	2908 228TH AVE SE
Second Line	:
City	:	SAMMAMISH
State	:	WA
Zip	:	98075-9306
Country	:	US
Telephone Number	:	425-391-9414
Fax Number	:

Provider Business Practice Location Address
First Line	:	2908 228TH AVE SE
Second Line	:
City	:	SAMMAMISH
State	:	WA
Zip	:	98075-9306
Country	:	US
Telephone Number	:	425-391-9414
Fax Number	:

Authorized Official
Title or Position	:	RDO
Name	:	DAWN MCCONKEY
Credential	:
Telephone Number	:	772-559-5343

Provider Enumeration Date	:	01/09/2026
Last Update Date	:	01/09/2026

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