Provider Demographics
NPI:1548515216
Name:STIREWALT PC
Entity type:Organization
Organization Name:STIREWALT PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:STIREWALT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-428-2000
Mailing Address - Street 1:24040 SE KENT KANGLEY RD
Mailing Address - Street 2:SUITE E200
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038
Mailing Address - Country:US
Mailing Address - Phone:714-428-2000
Mailing Address - Fax:
Practice Address - Street 1:24040 SE KENT KANGLEY RD
Practice Address - Street 2:SUITE E200
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038
Practice Address - Country:US
Practice Address - Phone:714-428-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty