Provider Demographics
NPI:1871968669
Name:DKEIDEK, FERNYHOUGH, GILE, HAGEL, NOV & QUICKSTAD PLLC
Entity type:Organization
Organization Name:DKEIDEK, FERNYHOUGH, GILE, HAGEL, NOV & QUICKSTAD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:GILE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PS
Authorized Official - Phone:425-747-9141
Mailing Address - Street 1:14715 BEL RED RD STE 200
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-3940
Mailing Address - Country:US
Mailing Address - Phone:425-747-9141
Mailing Address - Fax:
Practice Address - Street 1:14715 BEL RED RD STE 200
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3940
Practice Address - Country:US
Practice Address - Phone:425-747-9141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-06
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty