MEDICARE: DKEIDEK, FERNYHOUGH, GILE, HAGEL, NOV & QUICKSTAD 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	1223P0300X	Periodontics

General Provider Information

NPI Number	:	1962340653
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DKEIDEK, FERNYHOUGH, GILE, HAGEL, NOV & QUICKSTAD PLLC

Provider Business Mailing Address
First Line	:	304 W BAY DR NW STE 201
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502-4954
Country	:	US
Telephone Number	:	360-459-5900
Fax Number	:

Provider Business Practice Location Address
First Line	:	304 W BAY DR NW STE 201
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502-4954
Country	:	US
Telephone Number	:	360-459-5900
Fax Number	:

Authorized Official
Title or Position	:	RCM
Name	:	JANA JOHNSON
Credential	:
Telephone Number	:	206-430-2274

Provider Enumeration Date	:	03/23/2026
Last Update Date	:	03/23/2026

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