Healthcare Provider Details

I. General information

NPI: 1700960978
Provider Name (Legal Business Name): JULIE GRACE STONE L.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 COOPER POINT RD SW STE B3
OLYMPIA WA
98502-1110
US

IV. Provider business mailing address

1700 COOPER POINT RD SW STE B3
OLYMPIA WA
98502-1110
US

V. Phone/Fax

Practice location:
  • Phone: 360-943-6290
  • Fax: 360-943-8505
Mailing address:
  • Phone: 360-943-6290
  • Fax: 360-943-8505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License NumberDN0033
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: