Individual
STEPHANIE PEDERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
4701 MIDVALE AVE N, SEATTLE, WA 98103-6641
(206) 547-5647
Mailing address
4701 MIDVALE AVE N, SEATTLE, WA 98103-6641
(206) 547-5647
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DE60970314
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DE60970314
LICENSE NUMBER
WA
Enumeration date
11/06/2019
Last updated
11/27/2023
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