MEDICARE: JASON PEHLING DDS MS PC

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	1223G0001X	General Practice Dentistry	DE00008992	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	93200	OTHER	WA	REGENCE
2	47570	OTHER	WA	PREMERA DENTAL
3	SB930	OTHER	WA	PREMERA MEDICAL

General Provider Information

NPI Number	:	1376598847
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JASON PEHLING DDS MS PC

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

Provider Business Practice Location Address
First Line	:	2111 N NORTHGATE WAY
Second Line	:	STE 221
City	:	SEATTLE
State	:	WA
Zip	:	98133-9018
Country	:	US
Telephone Number	:	206-363-8240
Fax Number	:	206-363-8301

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JASON P PEHLING
Credential	:	DDS MS
Telephone Number	:	206-363-8240

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	04/25/2012

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