Provider Demographics
NPI:1215365580
Name:JOHN W STIEBER DDS PS
Entity Type:Organization
Organization Name:JOHN W STIEBER DDS PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:R
Authorized Official - Last Name:GIMSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-745-6322
Mailing Address - Street 1:1025 153RD ST SE STE 102
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-4051
Mailing Address - Country:US
Mailing Address - Phone:425-745-6322
Mailing Address - Fax:425-743-0326
Practice Address - Street 1:1025 153RD ST SE STE 102
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-4051
Practice Address - Country:US
Practice Address - Phone:425-745-6322
Practice Address - Fax:425-743-0326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-24
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1235361031OtherNPI TYPE 1