Provider Demographics
NPI:1942737085
Name:JENNIFER MAO STINDE DDS PLLC
Entity Type:Organization
Organization Name:JENNIFER MAO STINDE DDS PLLC
Other - Org Name:CRYSTAL SPRINGS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:STINDE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-859-8753
Mailing Address - Street 1:1732 214TH ST SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-7632
Mailing Address - Country:US
Mailing Address - Phone:425-485-2942
Mailing Address - Fax:425-398-5933
Practice Address - Street 1:1732 214TH ST SE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-7632
Practice Address - Country:US
Practice Address - Phone:425-485-2942
Practice Address - Fax:425-398-5933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60464622261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental