Healthcare Provider Details

I. General information

NPI: 1609871722
Provider Name (Legal Business Name): STEPHEN W GRINDALL D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8210 NAKETA BEACH WALK
MUKILTEO WA
98275-3148
US

IV. Provider business mailing address

8210 NAKETA BEACH WALK
MUKILTEO WA
98275-3148
US

V. Phone/Fax

Practice location:
  • Phone: 425-355-8866
  • Fax:
Mailing address:
  • Phone: 425-355-3215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4348
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: