# MATTHEW A. BAGNULO, DDS, PS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053978064
- **Authorized official:** MATTHEW ADAM BAGNULO DDS (OWNER)
- **Authorized official phone:** (425) 821-9000

## Contact information

- **Practice address:** 11830 NE 128TH ST., \#202, KIRKLAND, WA 98034
- **Practice address phone:** (425) 821-9000
- **Practice address fax:** (425) 814-2908
- **Mailing address:** 11830 NE 128TH ST., \#202, KIRKLAND, WA 98034
- **Mailing address phone:** (425) 821-9000
- **Mailing address fax:** (425) 814-2908

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 05/24/2019
- **Last updated:** 05/24/2019