Organization
STACEY KUTSCH, D.D.S., M.S., PLLC
Active
Other names
Walla Walla Pediatric Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STACEY RAE KUTSCH D.D.S., M.S. (OWNER PEDIATRIC DENTIST)
(509) 378-2520
Entity
Organization
Contact information
Practice address
614 E ALDER ST, SUITE 6, WALLA WALLA, WA 99362-2073
(509) 522-0555
Mailing address
614 E ALDER ST, SUITE 6, WALLA WALLA, WA 99362-2073
(509) 522-0555
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DE00010428
WA
261QD0000X
Dental Clinic/Center
DE00010428
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5050265
—
WA
01
—
CS10000430
CONSCIOUS SEDATION PERMIT
WA
01
—
DE00010428
DENTAL LICENSE
WA
Enumeration date
01/25/2014
Last updated
03/07/2023
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