Healthcare Provider Details

I. General information

NPI: 1568572006
Provider Name (Legal Business Name): LISA ANN KINNEY D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 S COLUMBIAN WAY
SEATTLE WA
98108-1532
US

IV. Provider business mailing address

121 LAKESIDE AVE APT 404
SEATTLE WA
98122-6588
US

V. Phone/Fax

Practice location:
  • Phone: 206-764-2334
  • Fax: 206-768-5382
Mailing address:
  • Phone: 206-764-2334
  • Fax: 206-768-5382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDE00007866
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: