Healthcare Provider Details

I. General information

NPI: 1962903112
Provider Name (Legal Business Name): PRESTON JOHN DEKKER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2018
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15421 MAIN ST STE 101
MILL CREEK WA
98012-9002
US

IV. Provider business mailing address

915 1ST ST S
KIRKLAND WA
98033-6528
US

V. Phone/Fax

Practice location:
  • Phone: 425-336-1894
  • Fax:
Mailing address:
  • Phone: 480-313-7636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number22DI03148100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number019.031837
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDE61485147
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: