Provider Demographics
NPI:1518085166
Name:CRISAFULLI, WENDY B (DDS, PS)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:B
Last Name:CRISAFULLI
Suffix:
Gender:F
Credentials:DDS, PS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9241 NE 173RD PL
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-3606
Mailing Address - Country:US
Mailing Address - Phone:425-483-5838
Mailing Address - Fax:425-398-5488
Practice Address - Street 1:18920 BOTHELL WAY NE
Practice Address - Street 2:#200
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-1981
Practice Address - Country:US
Practice Address - Phone:425-483-5838
Practice Address - Fax:425-398-5488
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA64491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice