Provider Demographics
NPI:1194188870
Name:PSPD - STANWOOD, PLLC
Entity Type:Organization
Organization Name:PSPD - STANWOOD, PLLC
Other - Org Name:PUGET SOUND PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTS RECEIVABLE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:R
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-339-8000
Mailing Address - Street 1:919 STATE AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-4284
Mailing Address - Country:US
Mailing Address - Phone:360-659-8100
Mailing Address - Fax:360-659-8133
Practice Address - Street 1:7104 265TH ST NW STE 110
Practice Address - Street 2:
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292-6250
Practice Address - Country:US
Practice Address - Phone:360-339-8000
Practice Address - Fax:360-339-8044
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LUGO DMD MARYSVILLE PS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-31
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000099181223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty