Provider Demographics
NPI:1639625072
Name:MICHAEL STAFFORD, DDS, PLLC
Entity Type:Organization
Organization Name:MICHAEL STAFFORD, DDS, PLLC
Other - Org Name:ADAMS VIEW DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:STAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:509-829-6611
Mailing Address - Street 1:PO BOX 537
Mailing Address - Street 2:
Mailing Address - City:ZILLAH
Mailing Address - State:WA
Mailing Address - Zip Code:98953-0537
Mailing Address - Country:US
Mailing Address - Phone:509-829-6611
Mailing Address - Fax:509-829-6663
Practice Address - Street 1:111 1ST AVE
Practice Address - Street 2:
Practice Address - City:ZILLAH
Practice Address - State:WA
Practice Address - Zip Code:98953-9779
Practice Address - Country:US
Practice Address - Phone:509-829-6611
Practice Address - Fax:509-829-6663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-26
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental