Provider Demographics
NPI:1336606300
Name:WOOLSEY, STEPHANIE (DDS)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:WOOLSEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 SW BOND ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3798
Mailing Address - Country:US
Mailing Address - Phone:541-389-3073
Mailing Address - Fax:
Practice Address - Street 1:400 SW BOND ST STE 100
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3798
Practice Address - Country:US
Practice Address - Phone:541-389-3073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-26
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD114381223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty