1962457036 NPI number — DR. JASON P PEHLING DDS, MS

Table of content: DR. JASON P PEHLING DDS, MS (NPI 1962457036)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962457036 NPI number — DR. JASON P PEHLING DDS, MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEHLING
Provider First Name:
JASON
Provider Middle Name:
P
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS, MS
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:
1962457036
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/24/2008
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
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:
05/24/2006

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 , 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: 155609 . This is a "LABOR AND INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 62308 . This is a "CIGNA" 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".
  • Identifier: 91131 . This is a "CARPENTER'S HEALTH PLAN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 93200 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 77777 . This is a "DELTA DENTAL" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 932000 . This is a "REGENCE" identifier . 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: 60054 . This is a "AETNA DENTAL" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 60054 . This is a "AETNA MEDICAL" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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