Healthcare Provider Details

I. General information

NPI: 1861817793
Provider Name (Legal Business Name): DAVID KRAAYENBRINK D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2014
Last Update Date: 07/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

U OF WASHINGTON DEPARTMENT OF ORAL SURGERY 1959 NE PACIFIC STREET; BOX 357134
SEATTLE WA
98195-0001
US

IV. Provider business mailing address

U OF WASHINGTON DEPARTMENT OF ORAL SURGERY 1959 NE PACIFIC STREET; BOX 357134
SEATTLE WA
98195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 360-318-4501
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDR60468172
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: