Provider Demographics
NPI:1487200531
Name:G. B. STAHL, DDS, PLLC
Entity Type:Organization
Organization Name:G. B. STAHL, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:STAHL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-641-3668
Mailing Address - Street 1:14030 NE 24TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007
Mailing Address - Country:US
Mailing Address - Phone:425-641-3668
Mailing Address - Fax:425-747-7611
Practice Address - Street 1:14030 NE 24TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007
Practice Address - Country:US
Practice Address - Phone:425-641-3668
Practice Address - Fax:425-747-7611
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GANNON B. STAHL DDS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty