MEDICARE: JOSEPH Y. DE JESUS, DDS, PS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1093671620
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSEPH Y. DE JESUS, DDS, PS

Provider Business Mailing Address
First Line	:	3242 CAPITOL BLVD SE
Second Line	:
City	:	TUMWATER
State	:	WA
Zip	:	98501-3304
Country	:	US
Telephone Number	:	360-943-4531
Fax Number	:	360-357-4659

Provider Business Practice Location Address
First Line	:	3242 CAPITOL BLVD SE
Second Line	:
City	:	TUMWATER
State	:	WA
Zip	:	98501-3304
Country	:	US
Telephone Number	:	360-943-4531
Fax Number	:	360-357-4659

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSEPH Y DE JESUS
Credential	:	DDS, MSD
Telephone Number	:	360-943-4531

Provider Enumeration Date	:	12/29/2025
Last Update Date	:	12/29/2025

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