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General NPI Number Information
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NPI Number | 1164360855
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Entity Type | Organization
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Legal Business Name | DKEIDEK, FERNYHOUGH, GILE, HAGEL, NOV & QUICKSTAD PLLC
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Dates
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Enumeration Date | 03/23/2026
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Last Update Date | 03/23/2026
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Provider Practice Location Address
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Address Line | 2737 77TH AVE SE STE 212
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City | MERCER ISLAND
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State | WA
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Zip | 98040-2832
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Country | US
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Telephone | 206-232-0683
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Fax |
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Provider Business Mailing Address
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Address Line | 2737 77TH AVE SE STE 212
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City | MERCER ISLAND
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State | WA
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Zip | 98040-2832
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Country | US
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Telephone | 206-232-0683
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Fax |
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Authorized Official
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Title or Position | RCM
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Name | JANA JOHNSON
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Credential |
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Telephone | 206-430-2274
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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