1467462200 NPI number — JEFFREYSTRAMMELLDDS,CHRISTOPHERPTRAMMELLDDS,TIMOTHYGGUTMANNDDS,ROSSDAU

Table of content: (NPI 1467462200)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467462200 NPI number — JEFFREYSTRAMMELLDDS,CHRISTOPHERPTRAMMELLDDS,TIMOTHYGGUTMANNDDS,ROSSDAU

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFFREYSTRAMMELLDDS,CHRISTOPHERPTRAMMELLDDS,TIMOTHYGGUTMANNDDS,ROSSDAU
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:
CHALET DENTAL
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:
1467462200
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1006 S 64TH AVE STE 130
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YAKIMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98908-2090
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-965-0080
Provider Business Mailing Address Fax Number:
509-965-7328

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1006 S 64TH AVE STE 130
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98908-2090
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-965-0080
Provider Business Practice Location Address Fax Number:
509-965-7328
Provider Enumeration Date:
08/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MAYHAK
Authorized Official First Name:
SANDRA
Authorized Official Middle Name:
Authorized Official Title or Position:
INSURANCE ADMIN. AND CREDENTIALING
Authorized Official Telephone Number:
509-965-0080

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , 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: 5015201 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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