Provider Demographics
NPI:1417144866
Name:STINSON, STEPHANIE (DMD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:STINSON
Suffix:
Gender:F
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:PO BOX 511
Mailing Address - Street 2:19 - 4TH STREET W
Mailing Address - City:TONASKET
Mailing Address - State:WA
Mailing Address - Zip Code:98855-0511
Mailing Address - Country:US
Mailing Address - Phone:509-486-8001
Mailing Address - Fax:509-486-8002
Practice Address - Street 1:19 - 4TH STREET W
Practice Address - Street 2:
Practice Address - City:TONASKET
Practice Address - State:WA
Practice Address - Zip Code:98855-0511
Practice Address - Country:US
Practice Address - Phone:509-486-8001
Practice Address - Fax:509-486-8002
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00011120122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1871854810OtherORGANIZATION NPI# DR STEPHANIE STINSON PLLC
WADE00011120OtherWA STATE LICENSE NUMBER