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General NPI Number Information
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NPI Number | 1659505097
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Entity Type | Organization
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Legal Business Name | MUKILTEO SMILES, STACEY C. SYPE, DDS, PLLC
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Dates
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Enumeration Date | 05/13/2009
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Last Update Date | 05/13/2009
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Provider Practice Location Address
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Address Line | 4901 81ST PL SW
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City | MUKILTEO
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State | WA
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Zip | 98275-2619
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Country | US
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Telephone | 425-438-2400
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Fax | 425-438-3833
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Provider Business Mailing Address
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Address Line | 4901 81ST PL SW
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City | MUKILTEO
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State | WA
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Zip | 98275-2619
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Country | US
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Telephone | 425-438-2400
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Fax | 425-438-3833
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | MRS. STACEY CAROL SYPE
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Credential | D.D.S.
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Telephone | 425-438-2400
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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 | DE00010753
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License Number State | WA
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