Active NPI
Staci A Bermudez, RDH
- Dental Hygienist
- Poulsbo, WA
National Provider Identifier
1346895869
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- HL60609954
- Practice address
- 2235 NE Castle Dr
Poulsbo, WA 98370-8068 - Phone
- (206) 745-3808
- Fax
- (206) 745-3811
- NPI assigned
- Aug 2, 2019
- Last updated
- Aug 2, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | HL60609954 | WA | Primary |
Addresses
Primary practice location
2235 NE Castle Dr
Poulsbo, WA 98370-8068
Mailing address
3377 Bethel Rd SE # 107-155
Port Orchard, WA 98366-5608
Phone (360) 602-9493
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| HL60609954 | WA | MD | Dental Hygienist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sarah Luetke, PLLC | Dental Hygienist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1564704000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1564704000000",
"number": "1346895869",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3377 BETHEL RD SE # 107-155",
"city": "PORT ORCHARD",
"state": "WA",
"postal_code": "983665608",
"telephone_number": "360-602-9493",
"fax_number": "206-745-3811"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2235 NE CASTLE DR",
"city": "POULSBO",
"state": "WA",
"postal_code": "983708068",
"telephone_number": "206-745-3808",
"fax_number": "206-745-3811"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERMUDEZ",
"first_name": "STACI",
"middle_name": "A",
"credential": "RDH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-08-02",
"last_updated": "2019-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "WA",
"license": "HL60609954",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Poulsbo, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.