Provider Demographics
NPI:1003836586
Name:STAMBAUGH, KATHLEEN A (DDS)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:STAMBAUGH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E GEORGE HOPPER RD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-3125
Mailing Address - Country:US
Mailing Address - Phone:360-757-7667
Mailing Address - Fax:360-707-2114
Practice Address - Street 1:120 E GEORGE HOPPER RD
Practice Address - Street 2:SUITE 215
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-3125
Practice Address - Country:US
Practice Address - Phone:360-757-7667
Practice Address - Fax:360-707-2114
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA68001223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics