Healthcare Provider Details

I. General information

NPI: 1255701033
Provider Name (Legal Business Name): MCLAUGHLIN - STONEBRAKER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2015
Last Update Date: 10/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7530 164TH AVE NE #A-130
REDMOND WA
98052-7808
US

IV. Provider business mailing address

7530 164TH AVE NE STE A130
REDMOND WA
98052-7837
US

V. Phone/Fax

Practice location:
  • Phone: 425-885-0008
  • Fax: 425-885-5093
Mailing address:
  • Phone: 425-885-0008
  • Fax: 425-885-5093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: JODI MILHOLLAND
Title or Position: BILLING MANAGER
Credential:
Phone: 425-885-0008