MEDICARE: MAGELSEN ANDELIN, PLLC

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	261QD0000X	Dental Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1679798508	OTHER	WA	SHAWN MAGELSEN DMD PLLC

General Provider Information

NPI Number	:	1942933478
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAGELSEN ANDELIN, PLLC

Provider Business Mailing Address
First Line	:	9612 270TH ST NW STE F
Second Line	:
City	:	STANWOOD
State	:	WA
Zip	:	98292-1906
Country	:	US
Telephone Number	:	360-629-1776
Fax Number	:

Provider Business Practice Location Address
First Line	:	9612 270TH ST NW STE F
Second Line	:
City	:	STANWOOD
State	:	WA
Zip	:	98292-1906
Country	:	US
Telephone Number	:	360-629-1776
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. MATTHEW ANDELIN
Credential	:	DMD
Telephone Number	:	425-345-5340

Provider Enumeration Date	:	07/01/2022
Last Update Date	:	07/01/2022

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