Carol Stockhausen, DDS
Individual provider Active NPI Dentist · Connell, WA
NPI 1124576129 · NPPES record last updated Sep 19, 2016
Key facts
- NPI
- 1124576129
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DE60679859 (WA)
- Practice address
- 1301 N Ephrata Ave
Connell, WA 99326-9601 - Phone
- (509) 543-5800
- NPI assigned
- Sep 19, 2016
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DE60679859 | WA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Washington State Department of Corrections Coyote Ridge Corrections Ce | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DE60679859 | WA | Yes |
Addresses
Primary practice location
1301 N Ephrata Ave
Connell, WA 99326-9601
Mailing address
250 Gage Blvd Apt a-2001
Richland, WA 99352-9605
Other providers in Connell, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 19, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.