Healthcare Provider Details

I. General information

NPI: 1922028935
Provider Name (Legal Business Name): KELLY RAE GARWOOD DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY RAE GARWOOD DDS

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 02/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 MAIN AVE N
NORTH BEND WA
98045
US

IV. Provider business mailing address

PO BOX 372
NORTH BEND WA
98045
US

V. Phone/Fax

Practice location:
  • Phone: 425-888-0867
  • Fax: 425-888-6585
Mailing address:
  • Phone: 425-888-0867
  • Fax: 425-888-6585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE00008063
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: