Provider Demographics
NPI:1003947334
Name:GILMORE, STACY SKOPELITIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:SKOPELITIS
Last Name:GILMORE
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 1:3216 NE 45TH PL
Mailing Address - Street 2:#302
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-4093
Mailing Address - Country:US
Mailing Address - Phone:206-522-0443
Mailing Address - Fax:206-522-0445
Practice Address - Street 1:3216 NE 45TH PL
Practice Address - Street 2:#302
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4093
Practice Address - Country:US
Practice Address - Phone:206-522-0443
Practice Address - Fax:206-522-0445
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00005831122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist