1609863059 NPI number — DR. ERIK MELVIN TJELMELAND DDS

Table of content: DR. ERIK MELVIN TJELMELAND DDS (NPI 1609863059)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609863059 NPI number — DR. ERIK MELVIN TJELMELAND DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TJELMELAND
Provider First Name:
ERIK
Provider Middle Name:
MELVIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609863059
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6441 TURNBERRY LN SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLYMPIA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98501-9114
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-438-2804
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
62D MEDICAL GROUP/SGOD
Provider Second Line Business Practice Location Address:
690 BARNES STREET
Provider Business Practice Location Address City Name:
MCCHORD AFB
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98438-1303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-438-2804
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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