Provider Demographics
NPI:1023160363
Name:CARSTENSEN, STEPHEN WILLIAM (DDS)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:WILLIAM
Last Name:CARSTENSEN
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 1:14535 NE BEL RED RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-3907
Mailing Address - Country:US
Mailing Address - Phone:425-698-1732
Mailing Address - Fax:425-746-0146
Practice Address - Street 1:14535 NE BEL RED RD STE 101
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3907
Practice Address - Country:US
Practice Address - Phone:425-698-1732
Practice Address - Fax:425-746-0146
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00006409122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6416950001Medicare NSC
WAG8899227Medicare PIN