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General NPI Number Information
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NPI Number | 1710127030
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Entity Type | Organization
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Legal Business Name | HYODOLEEMAGELSENYI III, PLLC
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Dates
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Enumeration Date | 02/26/2009
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Last Update Date | 02/26/2009
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Provider Practice Location Address
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Address Line | 2704 -171ST PL. NE, SUITE L-101
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City | MARYSVILLE
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State | WA
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Zip | 98271-4712
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Country | US
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Telephone | 360-652-1400
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Fax | 360-652-1433
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Provider Business Mailing Address
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Address Line | 2704 -171ST PL. NE, SUITE L-101
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City | MARYSVILLE
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State | WA
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Zip | 98271-4712
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Country | US
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Telephone | 360-652-1400
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Fax | 360-652-1433
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Authorized Official
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Title or Position | PARTNER/OWNER
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Name | DR. SHAWN F MAGELSEN
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Credential | DDS
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Telephone | 360-652-1400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 602870164
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License Number State | WA
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