# DAVINCI DENTAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366822017
- **Authorized official:** DR. BEAU JEROME KELLER DDS (DENTIST)
- **Authorized official phone:** (425) 409-9999

## Contact information

- **Practice address:** 909 112TH AVE NE STE P104, DAVINCI DENTAL, BELLEVUE, WA 98004-8589
- **Practice address phone:** (425) 409-9999
- **Mailing address:** 909 112TH AVE NE STE P104, DAVINVI DENTAL, BELLEVUE, WA 98004-8589
- **Mailing address phone:** (425) 409-9999

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 60555911 | WA | Yes |

## Other

- **Enumeration date:** 06/08/2015
- **Last updated:** 06/08/2015