Provider Demographics
NPI:1275691834
Name:MARANDAS, STEVEN G (DMD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:G
Last Name:MARANDAS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1452 HUDSON ST
Mailing Address - Street 2:SUITE#200
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-3066
Mailing Address - Country:US
Mailing Address - Phone:360-425-9090
Mailing Address - Fax:360-425-7323
Practice Address - Street 1:1452 HUDSON ST
Practice Address - Street 2:SUITE #200
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-3066
Practice Address - Country:US
Practice Address - Phone:360-425-9090
Practice Address - Fax:360-425-7323
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAD8959122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5046883Medicaid