Healthcare Provider Details

I. General information

NPI: 1962884494
Provider Name (Legal Business Name): MAURISSA KIEFER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2015
Last Update Date: 03/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 TERRY AVE N SUITE 100
SEATTLE WA
98109-5206
US

IV. Provider business mailing address

225 TERRY AVE N SUITE 100
SEATTLE WA
98109-5206
US

V. Phone/Fax

Practice location:
  • Phone: 206-622-2999
  • Fax: 206-622-9102
Mailing address:
  • Phone: 206-622-2999
  • Fax: 206-622-9102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE 60614517
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: