Provider Demographics
NPI:1770644494
Name:DORSEY, STEPHEN K (DDS)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:K
Last Name:DORSEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2908 228TH AVE SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98075-9306
Mailing Address - Country:US
Mailing Address - Phone:425-391-9414
Mailing Address - Fax:
Practice Address - Street 1:2908 228TH AVE SE
Practice Address - Street 2:SUITE A
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98075-9306
Practice Address - Country:US
Practice Address - Phone:425-391-9414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA69481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice