=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053970210
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARK STUDENY, DDS, PLLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2019
-----------------------------------------------------
Last Update Date | 04/19/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 411 STRANDER BLVD STE 205
-----------------------------------------------------
City | TUKWILA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98188-2959
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-430-5481
-----------------------------------------------------
Fax | 206-430-5481
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 411 STRANDER BLVD STE 205
-----------------------------------------------------
City | TUKWILA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98188-2959
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-430-5481
-----------------------------------------------------
Fax | 206-430-5481
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | MARK DANIEL STUDENY
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 206-890-4598
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------