Provider Demographics
NPI:1659505097
Name:MUKILTEO SMILES, STACEY C. SYPE, DDS, PLLC
Entity Type:Organization
Organization Name:MUKILTEO SMILES, STACEY C. SYPE, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:SYPE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-438-2400
Mailing Address - Street 1:4901 81ST PL SW
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-2619
Mailing Address - Country:US
Mailing Address - Phone:425-438-2400
Mailing Address - Fax:425-438-3833
Practice Address - Street 1:4901 81ST PL SW
Practice Address - Street 2:
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-2619
Practice Address - Country:US
Practice Address - Phone:425-438-2400
Practice Address - Fax:425-438-3833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00010753122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty