Healthcare Provider Details

I. General information

NPI: 1558890319
Provider Name (Legal Business Name): KEY CENTER FAMILY DENTISTRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9013 KEY PENINSULA HWY N
LAKEBAY WA
98349-8518
US

IV. Provider business mailing address

9013 KEY PENINSULA HWY N
LAKEBAY WA
98349-8518
US

V. Phone/Fax

Practice location:
  • Phone: 253-884-9455
  • Fax:
Mailing address:
  • Phone: 253-884-9455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE60369651
License Number StateWA

VIII. Authorized Official

Name: DR. MATTHEW JOEL COZBY
Title or Position: OWNER
Credential: DDS
Phone: 253-884-9455