Provider Demographics
NPI:1962884494
Name:KIEFER, MAURISSA (DDS)
Entity type:Individual
Prefix:
First Name:MAURISSA
Middle Name:
Last Name:KIEFER
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 1:225 TERRY AVE N
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-5206
Mailing Address - Country:US
Mailing Address - Phone:206-622-2999
Mailing Address - Fax:206-622-9102
Practice Address - Street 1:225 TERRY AVE N
Practice Address - Street 2:SUITE 100
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-5206
Practice Address - Country:US
Practice Address - Phone:206-622-2999
Practice Address - Fax:206-622-9102
Is Sole Proprietor?:No
Enumeration Date:2015-06-21
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 60614517122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist