Healthcare Provider Details

I. General information

NPI: 1093168791
Provider Name (Legal Business Name): AMANDA MCCAULEY DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2016
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18323 98TH AVE NE SUITE 2
BOTHELL WA
98011-3358
US

IV. Provider business mailing address

18323 98TH AVE NE SUITE 2
BOTHELL WA
98011-3358
US

V. Phone/Fax

Practice location:
  • Phone: 425-354-3138
  • Fax: 425-998-9334
Mailing address:
  • Phone: 425-354-3138
  • Fax: 425-998-9334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberDE60460512
License Number StateWA

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. AMANDA KOEPPEL MCCAULEY
Title or Position: OWNER DENTIST
Credential: DDS
Phone: 425-354-3138