Provider Demographics
NPI:1578659389
Name:WATERMAN, STEPHEN IV (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:WATERMAN
Suffix:IV
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15224 MAIN ST.
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98912
Mailing Address - Country:US
Mailing Address - Phone:425-379-8020
Mailing Address - Fax:425-379-8022
Practice Address - Street 1:15224 MAIN ST.
Practice Address - Street 2:SUITE 300
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98912
Practice Address - Country:US
Practice Address - Phone:425-379-8020
Practice Address - Fax:425-379-8022
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000057681223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice