MEDICARE: DR. KATHLEEN ELIZABETH ISDITH DDS

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	DE00008182	WA

General Provider Information

NPI Number	:	1528178324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHLEEN ELIZABETH ISDITH DDS

Provider Business Mailing Address
First Line	:	4407 106TH ST SW STE B
Second Line	:
City	:	MUKILTEO
State	:	WA
Zip	:	98275-4750
Country	:	US
Telephone Number	:	425-353-1009
Fax Number	:	425-353-8517

Provider Business Practice Location Address
First Line	:	4407 106TH ST SW STE B
Second Line	:
City	:	MUKILTEO
State	:	WA
Zip	:	98275-4750
Country	:	US
Telephone Number	:	425-353-1009
Fax Number	:	425-353-8517

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	01/13/2026

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