Provider Demographics
NPI:1700960978
Name:STONE, JULIE GRACE (LD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:GRACE
Last Name:STONE
Suffix:
Gender:F
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 COOPER POINT RD SW STE B3
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-1110
Mailing Address - Country:US
Mailing Address - Phone:360-943-6290
Mailing Address - Fax:360-943-8505
Practice Address - Street 1:1700 COOPER POINT RD SW STE B3
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-1110
Practice Address - Country:US
Practice Address - Phone:360-943-6290
Practice Address - Fax:360-943-8505
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN0033122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5021563Medicaid
WA5040498Medicaid