Healthcare Provider Details

I. General information

NPI: 1134501844
Provider Name (Legal Business Name): KARYN MAI, DDS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

617 CEMETERY RD
WINLOCK WA
98596-9303
US

IV. Provider business mailing address

617 CEMETERY RD
WINLOCK WA
98596-9303
US

V. Phone/Fax

Practice location:
  • Phone: 360-785-4755
  • Fax: 360-785-3336
Mailing address:
  • Phone: 360-785-4755
  • Fax: 360-785-3336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE60543546
License Number StateWA

VIII. Authorized Official

Name: DR. KARYN MAI
Title or Position: OWNER
Credential: DDS
Phone: 360-785-4755