MEDICARE: DR. GANNON BLAKE STAHL DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	10985	WA
2	1223G0001X	General Practice Dentistry	DE00010985	WA

General Provider Information

NPI Number	:	1598959413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GANNON BLAKE STAHL DDS

Provider Business Mailing Address
First Line	:	14030 NE 24TH ST STE 100
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98007-3724
Country	:	US
Telephone Number	:	425-641-3668
Fax Number	:	425-747-7611

Provider Business Practice Location Address
First Line	:	14030 NE 24TH ST STE 100
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98007-3724
Country	:	US
Telephone Number	:	425-641-3668
Fax Number	:	425-747-7611

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2007
Last Update Date	:	08/27/2019

Similar Medicare Providers

1801904925 — DR. ERNEST MOHANDAS MADHAVAN MD
Practice Location Address:

14030 NE 24TH ST , SUITE 104
BELLEVUE, WA
98007-3724

Practice Phone: 425-637-3976
Practice Fax:

1649379231 — EASTSIDE DERMATOLOGY INC PS
Practice Location Address:

14030 NE 24TH ST , SUITE 202
BELLEVUE, WA
98007-3724

Practice Phone: 425-454-1104
Practice Fax: 425-454-1290

1699850156 — DR. R. SCOTT CAHOON D.D.S., P.S.
Practice Location Address:

14030 NE 24TH STREET , #100
BELLEVUE, WA
98007-3724

Practice Phone: 425-641-3668
Practice Fax: 425-747-7611

1780754820 — DR. RANDALL M. MAEBO D.D.S.
Practice Location Address:

14030 NE 24TH ST , SUITE 103
BELLEVUE, WA
98007-3724

Practice Phone: 425-644-8485
Practice Fax: 425-644-8420

1457623027 — HYE-JIN C GEHRING NP
Practice Location Address:

14030 NE 24TH ST STE 202
BELLEVUE, WA
98007-3724

Practice Phone: 425-454-1104
Practice Fax: 425-454-1290

1174077721 — JIMMY ZHU D.D.S.
Practice Location Address:

14030 NE 24TH ST , SUITE #103
BELLEVUE, WA
98007-3724

Practice Phone: 425-644-8485
Practice Fax:

Directions to “ DR. GANNON BLAKE STAHL DDS” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.