MEDICARE: KENNY TO DDS PLLC

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	1223G0001X	General Practice Dentistry	DE00011244	WA

General Provider Information

NPI Number	:	1750775862
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENNY TO DDS PLLC

Provider Business Mailing Address
First Line	:	2211 N 56TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-6203
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2211 N 56TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-6203
Country	:	US
Telephone Number	:	206-632-1313
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	KENNY TO
Credential	:	DDS
Telephone Number	:	206-235-2226

Provider Enumeration Date	:	03/26/2015
Last Update Date	:	03/26/2015

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