NPIMap

Organization Active NPI

Davinci Dental

  • Dental Clinic/Center
  • Bellevue, WA
National Provider Identifier
1366822017
Registry record updated Jun 8, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
60555911 Issued in WA
Legal business name
DAVINCI DENTAL
Practice address
909 112TH Ave NE Ste P104
Davinci Dental
Bellevue, WA 98004-8589
Phone
(425) 409-9999
NPI assigned
Jun 8, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Beau Jerome Keller, DDS
Title
Dentist
Phone
(425) 409-9999

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 60555911 WA Primary

Addresses

Primary practice location

909 112TH Ave NE Ste P104
Davinci Dental
Bellevue, WA 98004-8589

Mailing address

909 112TH Ave NE Ste P104
Davinvi Dental
Bellevue, WA 98004-8589
Phone (425) 409-9999

National Provider Directory

National Provider Directory
Tax ID family
Davinci Dental3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1433721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433721600000",
    "number": "1366822017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "909 112TH AVE NE STE P104",
            "address_2": "DAVINVI DENTAL",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980048589",
            "telephone_number": "425-409-9999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 112TH AVE NE STE P104",
            "address_2": "DAVINCI DENTAL",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980048589",
            "telephone_number": "425-409-9999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVINCI DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-08",
        "last_updated": "2015-06-08",
        "status": "A",
        "authorized_official_last_name": "KELLER",
        "authorized_official_first_name": "BEAU",
        "authorized_official_middle_name": "JEROME",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "425-409-9999",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "WA",
            "license": "60555911",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bellevue, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.