Healthcare Provider Details

I. General information

NPI: 1518085166
Provider Name (Legal Business Name): WENDY B CRISAFULLI D.D.S, P.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18920 BOTHELL WAY NE #200
BOTHELL WA
98011-1981
US

IV. Provider business mailing address

9241 NE 173RD PL
BOTHELL WA
98011-3606
US

V. Phone/Fax

Practice location:
  • Phone: 425-483-5838
  • Fax: 425-398-5488
Mailing address:
  • Phone: 425-483-5838
  • Fax: 425-398-5488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6449
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: