Healthcare Provider Details

I. General information

NPI: 1871968669
Provider Name (Legal Business Name): DKEIDEK, FERNYHOUGH, GILE, HAGEL, NOV & QUICKSTAD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2015
Last Update Date: 09/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14715 BEL RED RD STE 200
BELLEVUE WA
98007-3940
US

IV. Provider business mailing address

14715 BEL RED RD STE 200
BELLEVUE WA
98007-3940
US

V. Phone/Fax

Practice location:
  • Phone: 425-747-9141
  • Fax:
Mailing address:
  • Phone: 425-747-9141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. MIKE GILE
Title or Position: CHAIRMAN
Credential: D.D.S., P.S.
Phone: 425-747-9141