Provider Demographics
NPI:1942453964
Name:ROBERT M. GISWOLD, DDS
Entity Type:Organization
Organization Name:ROBERT M. GISWOLD, DDS
Other - Org Name:SARATOGA DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:GISWOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-221-6373
Mailing Address - Street 1:742 CAMANO AVE
Mailing Address - Street 2:SUITE 101A
Mailing Address - City:LANGLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98260-9570
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:742 CAMANO AVE
Practice Address - Street 2:SUITE 101A
Practice Address - City:LANGLEY
Practice Address - State:WA
Practice Address - Zip Code:98260-9570
Practice Address - Country:US
Practice Address - Phone:360-221-6373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-04
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00004739122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5051826Medicaid