Provider Demographics
NPI:1497912968
Name:GANNON B. STAHL DDS PC
Entity Type:Organization
Organization Name:GANNON B. STAHL DDS PC
Other - Org Name:PINEVIEW AESTHETIC & FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GANNON
Authorized Official - Middle Name:BLAKE
Authorized Official - Last Name:STAHL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-649-0800
Mailing Address - Street 1:14730 NE 8TH ST
Mailing Address - Street 2:STE. 105
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-4116
Mailing Address - Country:US
Mailing Address - Phone:425-649-0800
Mailing Address - Fax:425-649-0806
Practice Address - Street 1:14730 NE 8TH ST
Practice Address - Street 2:STE. 105
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-4116
Practice Address - Country:US
Practice Address - Phone:425-649-0800
Practice Address - Fax:425-649-0806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00010985261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental