MEDICARE: STEPHANIE WOOLSEY DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	D11438	OR

General Provider Information

NPI Number	:	1336606300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE WOOLSEY DDS

Provider Business Mailing Address
First Line	:	400 SW BOND ST STE 100
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97702-3798
Country	:	US
Telephone Number	:	541-389-3073
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 SW BOND ST STE 100
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97702-3798
Country	:	US
Telephone Number	:	541-389-3073
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2019
Last Update Date	:	10/27/2021

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Directions to “ STEPHANIE WOOLSEY DDS” Practice Location

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