Gannon Blake Stahl, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE00010985 Issued in WA

Practice address

14030 NE 24TH St Ste 100
Bellevue, WA 98007-3724

Phone

(425) 641-3668

Fax

(425) 747-7611

NPI assigned

Sep 4, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• G. B. Stahl, DDS, PLLC

  • Dentist
  • Bellevue, WA
  • NPI 1487200531
  NPD Authorized official
• Gannon B. Stahl DDS PC

  dba Pineview Aesthetic & Family Dentistry

  • Dental Clinic/Center
  • Bellevue, WA
  • NPI 1497912968
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1188864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566864000000",
    "number": "1598959413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14030 NE 24TH ST STE 100",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980073724",
            "telephone_number": "425-641-3668",
            "fax_number": "425-747-7611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14030 NE 24TH ST STE 100",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980073724",
            "telephone_number": "425-641-3668",
            "fax_number": "425-747-7611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAHL",
        "first_name": "GANNON",
        "middle_name": "BLAKE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-09-04",
        "last_updated": "2019-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "10985",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE00010985",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stacie E. Maurer MD, PLLC
• Faith Stacy, M.ED.
• Stadelman Chiropractic and Wellness Center
• Peter N Stadelman, DC
• Martha Joe Staff, M.S., BCBA
• Luke Stambaugh, LMT
• Aaron Christopher Stamper, L.AC.
• Debiruth Stanford, LMHC, MA
• Dennyse Stanford, PH.D.
• Miik Wells Stanford Jr.

• General Practice Dentistry in Bellevue, WA
• Providers in Bellevue, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 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.

Verify at the official NPI Registry.