Provider Demographics
NPI:1083916738
Name:MARK STAHL, DDS, PS
Entity Type:Organization
Organization Name:MARK STAHL, DDS, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, SECRETARY, TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:STAHL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-522-0466
Mailing Address - Street 1:3216 NE 45TH PL
Mailing Address - Street 2:SUITE 213
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-4093
Mailing Address - Country:US
Mailing Address - Phone:206-522-0466
Mailing Address - Fax:206-522-0492
Practice Address - Street 1:3216 NE 45TH PL
Practice Address - Street 2:SUITE 213
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4093
Practice Address - Country:US
Practice Address - Phone:206-522-0466
Practice Address - Fax:206-522-0492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE600768901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty