Healthcare Provider Details

I. General information

NPI: 1306958160
Provider Name (Legal Business Name): ELIZABETH KUBICEK VELAN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 10/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 NE 74TH STREET
SEATTLE WA
98115
US

IV. Provider business mailing address

6222 NE 74TH STREET THE CENTER FOR PEDIATRIC DENTISTRY
SEATTLE WA
98115
US

V. Phone/Fax

Practice location:
  • Phone: 206-755-8507
  • Fax:
Mailing address:
  • Phone: 206-755-8507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDE00010226
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: