Provider Demographics
NPI:1134674773
Name:KATHLEEN A STAMBAUGH, DDS PS
Entity Type:Organization
Organization Name:KATHLEEN A STAMBAUGH, DDS PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-757-7667
Mailing Address - Street 1:120 E GEORGE HOPPER RD STE 215
Mailing Address - Street 2:
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 STE 215
Practice Address - Street 2:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6800261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental