Healthcare Provider Details

I. General information

NPI: 1861290553
Provider Name (Legal Business Name): JOSEPH EIDSNESS, DDS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2025
Last Update Date: 03/08/2025
Certification Date: 03/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7209 265TH ST NW STE 201
STANWOOD WA
98292-6292
US

IV. Provider business mailing address

5430 91ST ST NE
MARYSVILLE WA
98270-2642
US

V. Phone/Fax

Practice location:
  • Phone: 360-629-3133
  • Fax:
Mailing address:
  • Phone: 360-618-2877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH R EIDSNESS
Title or Position: PRACTICE OWNER
Credential: DDS
Phone: 360-618-2877