Provider Demographics
NPI:1528310638
Name:KEN AKIMOTO DDS MSD PLLC
Entity type:Organization
Organization Name:KEN AKIMOTO DDS MSD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:AKIMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-919-8421
Mailing Address - Street 1:1740 NW MAPLE ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-8127
Mailing Address - Country:US
Mailing Address - Phone:425-392-8992
Mailing Address - Fax:425-392-0184
Practice Address - Street 1:22516 SE 64TH PL
Practice Address - Street 2:SUITE 250
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-5379
Practice Address - Country:US
Practice Address - Phone:425-392-8992
Practice Address - Fax:425-392-0184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-12
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000091981223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty