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General NPI Number Information
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NPI Number | 1194188870
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Entity Type | Organization
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Legal Business Name | PSPD - STANWOOD, PLLC
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Dates
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Enumeration Date | 03/31/2016
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Last Update Date | 04/11/2022
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Provider Practice Location Address
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Address Line | 7104 265TH ST NW STE 110
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City | STANWOOD
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State | WA
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Zip | 98292-6250
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Country | US
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Telephone | 360-339-8000
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Fax | 360-339-8044
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Provider Business Mailing Address
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Address Line | 919 STATE AVE STE 104
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City | MARYSVILLE
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State | WA
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Zip | 98270-4284
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Country | US
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Telephone | 360-659-8100
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Fax | 360-659-8133
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Authorized Official
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Title or Position | ACCOUNTS RECEIVABLE MANAGER
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Name | MRS. JESSICA R. KNIGHT
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Credential |
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Telephone | 360-339-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DE00009918
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License Number State | WA
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