Provider Demographics
NPI:1366121733
Name:DO, STEPHANIE NGOC
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:NGOC
Last Name:DO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14411 NE FOURTH PLAIN BLVD STE 134
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-5001
Mailing Address - Country:US
Mailing Address - Phone:360-768-0936
Mailing Address - Fax:
Practice Address - Street 1:14411 NE FOURTH PLAIN BLVD STE 134
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-5001
Practice Address - Country:US
Practice Address - Phone:360-768-0936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-13
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist