Healthcare Provider Details

I. General information

NPI: 1053875096
Provider Name (Legal Business Name): KUTCIPAL & MAHIL DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2019
Last Update Date: 09/02/2025
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1448 NW MARKET STREET SUITE 230
SEATTLE WA
98107
US

IV. Provider business mailing address

1448 NW MARKET STREET SUITE 230
SEATTLE WA
98107
US

V. Phone/Fax

Practice location:
  • Phone: 206-783-9672
  • Fax: 206-784-4812
Mailing address:
  • Phone: 206-783-9672
  • Fax: 206-784-4812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH A KUTCIPAL
Title or Position: OWNER
Credential: DDS
Phone: 206-783-9672