# JOSEPH EIDSNESS, DDS, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Port Susan Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1861290553
- **Authorized official:** JOSEPH R EIDSNESS DDS (PRACTICE OWNER)
- **Authorized official phone:** (360) 618-2877

## Contact information

- **Practice address:** 7209 265TH ST NW STE 201, STANWOOD, WA 98292-6292
- **Practice address phone:** (360) 629-3133
- **Mailing address:** 5430 91ST ST NE, MARYSVILLE, WA 98270-2642
- **Mailing address phone:** (360) 618-2877

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 03/06/2025
- **Last updated:** 03/08/2025