1376598847 NPI number — JASON PEHLING DDS MS PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376598847 NPI number — JASON PEHLING DDS MS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JASON PEHLING DDS MS PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TMJ OROFACIAL DISORDERS CENTER
Provider Other Organization Name Type Code:
3
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:
1376598847
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2111 N NORTHGATE WAY
Provider Second Line Business Mailing Address:
STE 221
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98133
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-363-8240
Provider Business Mailing Address Fax Number:
206-363-8301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2111 N NORTHGATE WAY
Provider Second Line Business Practice Location Address:
STE 221
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98133-9018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-363-8240
Provider Business Practice Location Address Fax Number:
206-363-8301
Provider Enumeration Date:
05/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PEHLING
Authorized Official First Name:
JASON
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
206-363-8240

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  DE00008992 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 93200 . This is a "REGENCE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 47570 . This is a "PREMERA DENTAL" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: SB930 . This is a "PREMERA MEDICAL" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com