Provider Demographics
NPI:1710647714
Name:STEVIE AMES ROBERTS, DMD, PLLC
Entity Type:Organization
Organization Name:STEVIE AMES ROBERTS, DMD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVIE
Authorized Official - Middle Name:AMES
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:425-284-0515
Mailing Address - Street 1:5726 LAKE WASHINGTON BLVD NE STE S2
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-7398
Mailing Address - Country:US
Mailing Address - Phone:425-284-0515
Mailing Address - Fax:
Practice Address - Street 1:5726 LAKE WASHINGTON BLVD NE STE S2
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-7398
Practice Address - Country:US
Practice Address - Phone:425-284-0515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-19
Last Update Date:2021-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental