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General NPI Number Information
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NPI Number | 1376576660
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Entity Type | Individual
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Provider Name | STEPHANIE CHRISTINE MARVIN DDS
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Gender | Female
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 10/11/2023
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Provider Practice Location Address
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Address Line | 1959 NE PACIFIC STREET
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City | SEATTLE
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State | WA
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Zip | 98195-6370
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Country | US
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Telephone | 206-543-6501
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 99654
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City | SEATTLE
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State | WA
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Zip | 98139-0654
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Country | US
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Telephone | 206-353-5404
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DE00005087
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5087
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License Number State | WA
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