Provider Demographics
NPI:1063494805
Name:STANLEY, STEVEN M (DDS)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:M
Last Name:STANLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 N 200TH ST
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-3330
Mailing Address - Country:US
Mailing Address - Phone:206-542-1196
Mailing Address - Fax:206-546-1119
Practice Address - Street 1:1515 N 200TH ST
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-3330
Practice Address - Country:US
Practice Address - Phone:206-542-1196
Practice Address - Fax:206-546-1119
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA56871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice