Healthcare Provider Details

I. General information

NPI: 1215018429
Provider Name (Legal Business Name): DAVID A KILLEN D.D.S.,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 04/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 MALTBY RD SUITE #9
BOTHELL WA
98021-8669
US

IV. Provider business mailing address

2020 MALTBY RD SUITE #9
BOTHELL WA
98021-8669
US

V. Phone/Fax

Practice location:
  • Phone: 425-481-8280
  • Fax:
Mailing address:
  • Phone: 425-481-8280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE00007721
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: