MEDICARE: FACIAL DYNAMICS INTERNATIONAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	025103	WA

General Provider Information

NPI Number	:	1104910447
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FACIAL DYNAMICS INTERNATIONAL

Provider Business Mailing Address
First Line	:	3720 CALIFORNIA AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98116-3754
Country	:	US
Telephone Number	:	206-938-1113
Fax Number	:	206-937-7395

Provider Business Practice Location Address
First Line	:	3720 CALIFORNIA AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98116-3754
Country	:	US
Telephone Number	:	206-938-1113
Fax Number	:	206-937-7395

Authorized Official
Title or Position	:	CEO
Name	:	DR. ROBERT MICHAEL KEENAN
Credential	:	DDS
Telephone Number	:	206-938-1113

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	11/20/2008

Similar Medicare Providers

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Practice Location Address:

3720 CALIFORNIA AVE SW
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1306843933 — MRS. MONIKA TIMKA DALKIN PT
Practice Location Address:

4701 41ST AVE SW , STE 100
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1174524995 — DR. COOPER FRANCIS BOLAK DDS
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1558353888 — MS. NANCY LOUISE STOKLEY ARNP, RN, MN
Practice Location Address:

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Directions to “FACIAL DYNAMICS INTERNATIONAL ” Practice Location

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