Healthcare Provider Details

I. General information

NPI: 1790642908
Provider Name (Legal Business Name): COVINGTON FAMILY DENTAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2026
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17121 SE 270TH PL STE 202
COVINGTON WA
98042-5431
US

IV. Provider business mailing address

17121 SE 270TH PL STE 202
COVINGTON WA
98042-5431
US

V. Phone/Fax

Practice location:
  • Phone: 253-630-5500
  • Fax: 253-630-2930
Mailing address:
  • Phone: 253-630-5500
  • Fax: 253-630-2930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TAMMY KERRIGAN
Title or Position: FRONT OFFICE SUPERVISOR
Credential:
Phone: 253-630-5500