# MICHAEL CONWAY DDS PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Kenmore Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366748105
- **Authorized official:** MRS. TERI ANNE SHACKELFORD (OFFICE MANGER)
- **Authorized official phone:** (425) 485-0588

## Contact information

- **Practice address:** 5723 NE BOTHELL WAY STE B, KENMORE, WA 98028-9404
- **Practice address phone:** (425) 485-0588
- **Practice address fax:** (425) 483-6189
- **Mailing address:** 5723 NE BOTHELL WAY STE B, KENMORE, WA 98028-9404
- **Mailing address phone:** (425) 485-0588
- **Mailing address fax:** (425) 483-6189

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 7496 | WA | Yes |

## Other

- **Enumeration date:** 01/26/2011
- **Last updated:** 07/21/2016