Individual
DR. KEITH WAYNE MATHENY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
10803 SE KENT KANGLEY RD, SUITE #100, KENT, WA 98030-7194
(253) 859-0658
(253) 859-8052
Mailing address
10803 SE KENT KANGLEY RD, SUITE #100, KENT, WA 98030-7194
(253) 859-0658
(253) 859-8052
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5596
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5001581
DSHS
WA
01
—
56326
LABOR & INDUSTRIES
WA
Enumeration date
01/12/2006
Last updated
07/08/2007
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