Provider Demographics
NPI:1669695904
Name:SYPE, STACEY C (DDS)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:C
Last Name:SYPE
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 1:4901 81ST PLACE SW
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-2619
Mailing Address - Country:US
Mailing Address - Phone:425-438-2400
Mailing Address - Fax:425-438-3833
Practice Address - Street 1:4901 81ST PLACE SW
Practice Address - Street 2:
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-2619
Practice Address - Country:US
Practice Address - Phone:425-438-2400
Practice Address - Fax:425-438-3833
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE62641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice