Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DE00005831 | WA |
NPI | 1003947334 |
---|---|
Provider Name | Dr. Stacy Skopelitis Gilmore |
First Address | Seattle, WA 98105-4093 |
Second Address | Seattle, WA 98105-4093 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2007 |
Last Update Date | 08/07/2007 |