Individual
MISS HOLLY WALLSTROM STAGG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
16703 SE MCGILLIVRAY BLVD STE 100, VANCOUVER, WA 98683-3418
(360) 892-2994
Mailing address
16703 SE MCGILLIVRAY BLVD STE 100, VANCOUVER, WA 98683-3418
(360) 892-2994
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DE00011143
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DE00011143
STATE DENTAL LICENSE
WA
Enumeration date
10/03/2006
Last updated
08/03/2022
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