MEDICARE: DR. STEPHEN B HARDING D.D.S.

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	9018	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9018	OTHER	WA	LICENSE

General Provider Information

NPI Number	:	1972656742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN B HARDING D.D.S.

Provider Business Mailing Address
First Line	:	1705 COLE ST
Second Line	:
City	:	ENUMCLAW
State	:	WA
Zip	:	98022-3507
Country	:	US
Telephone Number	:	360-825-5585
Fax Number	:	360-825-5592

Provider Business Practice Location Address
First Line	:	1705 COLE ST
Second Line	:
City	:	ENUMCLAW
State	:	WA
Zip	:	98022-3507
Country	:	US
Telephone Number	:	360-825-5585
Fax Number	:	360-825-5592

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

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	07/08/2007

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Directions to “ DR. STEPHEN B HARDING D.D.S.” Practice Location

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