Provider Demographics
NPI:1982036430
Name:SONSTEGARD, GRIFFIN (DDS)
Entity Type:Individual
Prefix:
First Name:GRIFFIN
Middle Name:
Last Name:SONSTEGARD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15610 NE WOODINVILLE DUVALL RD STE 109
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-7069
Mailing Address - Country:US
Mailing Address - Phone:425-287-6082
Mailing Address - Fax:
Practice Address - Street 1:15610 NE WOODINVILLE DUVALL RD STE 109
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-7069
Practice Address - Country:US
Practice Address - Phone:425-287-6082
Practice Address - Fax:425-287-6083
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-07
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYDE612494061223S0112X
MND132661223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty