Provider Demographics
NPI:1346410719
Name:DKEIDEK, ALLYSON STEWART (DDS)
Entity type:Individual
Prefix:
First Name:ALLYSON
Middle Name:STEWART
Last Name:DKEIDEK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 E HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-3323
Mailing Address - Country:US
Mailing Address - Phone:716-725-4676
Mailing Address - Fax:
Practice Address - Street 1:4500 SAND POINT WAY NE
Practice Address - Street 2:SUITE 208
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3900
Practice Address - Country:US
Practice Address - Phone:206-525-4777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6197-15122300000X
WADE60124299122300000X
IN12011261A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33386500Medicaid
WI33730800Medicaid
WI33794900Medicaid
WA2008604Medicaid